Since rebuilding oversight and accountability of Medicare and Medicaid is the first step towards a healthy system---we need a strong public sector dedicated to our Federal Trusts. If we take Johns Hopkins East building in Waverly and make it public oversight for health care ---we are on the way to funding resourced doing what it is meant to.
Baltimore has always refused to provide health services to Medicaid and Medicare patients that states all over the nation did---it exempted itself out of Medicare oversight and then declared it part of a pool of money. Of course when Federal funds hit a pool of state money----it means it will be dispersed elsewhere. Baltimore City is now dismantling all of disability and senior services tied to Social Security Disability and Medicare/Medicaid by ending these public sector jobs and outsourcing----with the goal of ending them.
MTA in Baltimore is deliberately left defunded and a mess because poor people use it. O'Malley cut $10 million from only Baltimore's MTA and now Rawlings-Blake is outsourcing funding from the Transportation Fund to pay for temporary employment for services for seniors and disabled. So, the MTA Disability service was given to VEOLA and now seniors and disabled feel they cannot trust being picked up on time and or fear being left not able to get home while the MTA disability rides fall because the space in MTA buses are packed as buses fail to follow schedules. The disabled do not want to wait for a bus and find there is no space for them. Keep in mind, Baltimore has great numbers of disabled and seniors so these policies are causing people to stay home and become more dependent. Don't worry about being trapped at home---all of your health care will be done online and with unregulated and with no oversight home health care
THIS IS HOW YOU END SERVICE FOR THE PUBLIC---YOU MAKE IT TOO UNDEPENDABLE TO USE.
WOW! I cannot wait to age into all of that.
The shock you see below is being noticed because the new residents of Baltimore are seeing what the long-term have experienced for decades. All while Baltimore is completely Democratic......operating as Hopkins' neo-conservative. You see the Congressional, state, and Baltimore City Hall pols all working to make transportation for most difficult.
New to MTA bus commuting, shocked by the poor service A resident who depends on a regular MTA bus line wants to draw attention to the "severe dysfunction" of mass transit beyond the Charm City Circulator
Brian Levy October 27, 2014 at 10:03 am Baltimore Brew
EDITOR’s NOTE: This essay is adapted from an email written by an irate city resident to a list of public officials regarding the 13 bus line that runs the length of North Avenue. One of the city’s busiest routes, service is scheduled every 10 minutes on weekdays and Saturdays, every 15 minutes on Sundays.
I began taking the #13 bus line in September of this year. I take the route every day to and from work except those days where I have been forced to give up and walk or attempt to summon a cab.
The service has been consistently terrible since the very first day I took the line.
In general, the #13 bus is often late and is always overcrowded. I will point to two incidents, both occurring this week, which illustrate my concerns.
These instances are representative of the types of rides I encounter a few days every week since starting to ride this bus.
Doors Shut, Left Without Us
Last Wednesday, October 22nd, I arrived at the #13 bus stop on the corner of North Avenue and Charles Street heading east at 7:00 a.m. I waited till 7:40 a.m. before a bus finally came.
By the time it did arrive, a crowd of about 25 people had gathered to get on. However, the bus that had arrived was so full that the driver only allowed one person who was waiting on.
She then shut the doors and continued on her route without the rest of us.
Let me emphasize, this is not the first time that this has occurred to me. I was lucky enough to have the money to walk down three blocks and grab a cab. I was over an hour late for work that day.
Dodging Would-be Riders
Last Friday, October 24th, I waited for the #13 at 4:30 p.m. at the corner of Harford Road and North Avenue, heading west. About 12 people waited with me.
When the bus arrived all 12 of us packed on. The bus was so crowded that five of us had to stand in front of the yellow line next to the driver. (In plain view of the sign that states it is against federal law to stand in front of the yellow line).
Every seat on this bus was taken. Every inch of standing room was filled. The driver proceeded to skip the next three bus stops.
At each stop we passed dozens of people who were waiting. There was not a bus close behind us for them to grab.
When a passenger wanted to get off, the driver would pull over 100 yards before the bus stops to let passengers off, to ensure none of the anxious riders waiting at their stops for our overcrowded bus would attempt to get on. This is a common occurrence.
Hurting the Hurting Parts of Town
The city’s free Charm City Circulator buses, which run near the waterfront and in a few upscale areas, have been in the news lately over a possible fee charge as well as plans to expand service.
I’m trying to call attention to the severe dysfunction in the part of the city’s transit system that – unlike the Circulator – charges riders money and is supposed to serve the rest of Baltimore.
North Avenue, where the east-west #13 runs, connects some of the poorest parts of Baltimore. It cuts across our city’s midsection like an infected scar, with struggling neighborhoods to the north and south in quite poor shape along nearly the entire length.
There are abandoned houses and storefronts along most of the route I take. Many houses’ roofs are visibly caving in. Some, slightly less dilapidated homes have their boarded up windows and doors stamped with advertisements for the city’s Vacants to Value program.
I know the factors that caused this area of the city to fall into disrepair are numerous and complex. But surely, one factor that adds to this area’s woes is the poor state of the public transportation.
When the bus is late, or overcrowded, I and other riders like me are made late for our jobs, our appointments, our families and our lives.
A late bus is not simply an inconvenience, but a burden on the lives of those who rely on it. It is certainly a reason many lose employment, and it is certainly a reason many decide to leave the city if they can.
Rx for Troubled Route
The troubled bus route damages the quality of life for those with cars as well. It is also a deterrent to invest in the area.
Traveling along North Avenue, one sees crowds of people waiting for the bus. These crowds attract people trying to sell drugs, and are breeding grounds for conflicts and trouble of all sort. I can’t tell you how many times people have come up to me and the people I wait with for the bus attempting to sell narcotics.
Whether waiting for the bus yourself or just driving by, this atmosphere causes people to stay clear of the area.
For my sake, for my fellow passengers sake, for the sake of those who live and work on North Avenue and for the sake of our city – please heed my plea and do whatever is in your power to improve the service of the #13 line.
Making the route safer and more reliable for transit users could have a healing effect that would spread further into the community.
Brian Levy, a legal fellow with the Public Defender’s Office, recently moved with his fiance to the Midtown-Belvedere neighborhood. He says he sent this email to the Maryland Transit Administration; Mayor Stephanie Rawlings-Blake; City Councilmen Eric Costello, Nick Mosby and Carl Stokes; Maryland 40th District Delegates Frank M. Conway, Jr., Shawn Tarrant and Barbara Robinson; State Senator Catherine Pugh; U.S. Representative Elijah Cummings; and U.S. Senator Benjamin Cardin and Barbara Mikulski.
I wanted to show how Baltimore pols are committed to these dismantlings of our Federal Medicare and Medcaid programs. Now, people at first glance will say----ahhhh, look jobs for youth shoveling snow. If you look closer you see that a public sector service having always been covered by Medicare./SS Disability and covered by public sector employees is now being outsourced----and this time it falls under the temporary category of being funded from Transportation Funding to a program for temporary youth work.
Now, the disabled and seniors arlready have trouble with a defunded transportation funding for public transit as we saw above. So, Baltimore City Hall and Rawlings-Blake is taking more of the Transportation money to fund what should have been an existing public programs for seniors and disabled----shoveling snow.
If I were those Baltimore citizens I would wonder who will come when this temporary youth program ends and from where will the money come.
EXPANDED AND IMPROVED MEDICARE FOR ALL TAKES CARE OF ALL THESE EXTENSIONS OF HEALTH CARE AND PUBLIC SAFETY AND THERE IS PLENTY OF MONEY AVAILABLE FOR MEDICARE AND MEDICAID.
Baltimore will pay kids to shovel snow next winter
Jul 15, 2015, 3:03pm EDT Updated Jul 17, 2015, 3:23pm EDT Baltimore Business Journal.
Baltimore will extend its efforts to boost youth employment through the winter with a new… more
Children won't have to ring the doorbell to ask grandma if she wants her sidewalk shoveled this winter in Baltimore City.
The city Department of Transportation is starting a new youth snow program that will have young people clearing public sidewalks for older residents and those with disabilities. It will hire 200 to 400 youths between the ages of 14 and 21.
Young people participating will have the choice of receiving a stipend of at least $500 — depending on how much it snows — or credit hours that can be applied toward high school graduation. They will be assigned specific locations to shovel during snow emergencies, said said Richard Hooper, operations bureau chief for the department of transportation.
The snow removal program is an extension of recent efforts to boost youth employment in Baltimore, said Mayor Stephanie Rawlings-Blake, who announced it Wednesday. The city increased this year the number of summer jobs it offers through its YouthWorks program by nearly 3,000 to 8,000.
"We know that Baltimore's younger people are looking for employment beyond the summer," Rawlings-Blake said.
Funding for the program comes from the Department of Transportation snow budget. Participants will be issued shovels, gloves and safety vests. They will also go through orientation and training.
Here you see where this same service comes out of Medicaid funding------so in Baltimore where is that Medicaid funding going at the expense of transportation?
This is the problem for Maryland and especially Baltimore. Because the state places these funds in the state treasury as a pool-----they become so fungible that the needs and services of seniors and Medicaid-eligible are left unmet. We also see where the public sector structure in Baltimore for doing these things is gone.....
If an agency in Baltimore actually kept track of how many Medicaid and Medicare citizens and their needs and make sure all of those funds come to Baltimore from the State of Maryland----we would have plenty of funding for Expanded and Improved Medicare for All.
I attended a Maryland Assembly meeting where a very nice man with a non-profit for the aging asked that such a system be put into place-----as if it was not a NECESSARY REQUIREMENT FOR TRACKING FUNDS FOR MEDICARE AND MEDICAID. We may not be able to force the Maryland Assembly to build these tracking systems for our revenue---but we can build them in Baltimore where much of Medicare and Medicaid is spent.
Seniors, disabled residents can get help with snow removal
Published: Wednesday, January 12, 2011
By MATT DECEMBER
Romeo, Washington and Bruce residents may be eligible for assistance with snow removal this winter through the CHORE program. Call 752-9601 for more information.
As Michigan enters the heart of winter, northern Macomb County residents are reminded that they may qualify for assistance in removing snow from their residence.
The CHORE program provides free or low-cost snow removal services in the winter to seniors or residents with disabilities who live in Romeo, Washington Township or Bruce Township. The cost of the program is also income-based.
"If you are on Medicaid, there is no charge," said Debbie Webber, director of the senior centers in Romeo and Washington Township. "If we know someone is financially hurting it can be adjusted. It is very, very low-cost, even when we do charge."
The program is funded through several means, including Community Development Block Grant funds given on behalf of the communities.
If you hear people calling for single-payer without calling for Expanded and Improved Medicare for All they are working for this highly privatized Maryland version that basically allows for people's access to Medicare and Medicaid be different from that required by the Federal programs and what people access nationally. This is why Baltimore has the worst health and life expectancy in the US-----the pools of Federal funds were distributed all around Maryland to make sure hospitals giving expensive care did not lose money. This is what Maryland Health Care for All was created to support----it is the Johns Hopkins non-profits whose job is to make it seem like this is a good way to use Federal funds meant to give everyone equal coverage. If you think---that's OK----it's just the working class and poor getting screwed out of health care they were legally entitled to---WAKE UP----
AS YOU SEE BELOW MARYLAND IS GEARING UP TO MAKE SURE THAT MOST OF BABY BOOMERS DO NOT ACCESS THESE FEDERAL FUNDS AS THEY SHOULD.
I will talk more tomorrow on the details of these changes that came with Affordable Care Act and almost a $1 trillion cut from Medicare and Medicaid to pay down the debt created by massive corporate fraud. I would like people to think what happens when these health funds are allowed to be pooled and then distributed by arbitrary means by health corporations only interested in maximizing profits.
IF A POLITICIAN IS SUPPORTING ALL-PAYER THEY ARE WORKING TO END MEDICARE AND MEDICAID AND PUSHING OVER 80% OF AMERICANS ONTO PREVENTATIVE CARE ONLY AS DISABLED AND SENIORS. ALL-PAYER IS THE OPPOSITE OF EXPANDED AND IMPROVED MEDICARE FOR ALL.
Of course Donna Edwards is very proud to support All-Payers as does Chris Van Hollen because----they haven't said a word about a trillion dollars stolen from our health trusts over a few decades!
THAT'S HOW YOU KNOW A CLINTON NEO-LIBERAL! WHO IS RUNNING IN THIS DEMOCRATIC SENATE PRIMARY AGAINST THESE TWO NEO-LIBERALS?
Maryland All-Payer Model
The Centers for Medicare & Medicaid Services (CMS) and the state of Maryland are partnering to modernize Maryland’s unique all-payer rate-setting system for hospital services that will improve patients' health and reduce costs. This initiative will update Maryland’s 36-year-old Medicare waiver to allow the state to adopt new policies that reduce per capita hospital expenditures and improve health outcomes as encouraged by the Affordable Care Act.
Maryland operates the nation’s only all-payer hospital rate regulation system. This system is made possible, in part, by a 36-year-old Medicare waiver (codified in Section 1814(b) of the Social Security Act) that exempts Maryland from the Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS) and allows Maryland to set rates for these services. Under the waiver, all third parties pay the same rate. The State of Maryland and CMS expect that the All-Payer Model will be successful in improving the quality of care and reducing program expenditures for Maryland residents, including Medicare, Medicaid, and CHIP beneficiaries. Moreover, the Maryland system may serve as a model for other states interested in developing all-payer payment systems.
Maryland’s all-payer rate setting system for hospital services presents an opportunity for Maryland and CMS to test whether an all-payer system for hospital payment that is accountable for the total hospital cost of care on a per capita basis is an effective model for advancing better care, better health and reduced costs. Under the new model, Maryland hospitals will commit to achieving significant quality improvements, including reductions in Maryland hospitals’ 30-day hospital readmissions rate and hospital acquired conditions rate. Maryland will limit all-payer per capita hospital growth, including inpatient and outpatient care, to 3.58 percent. Maryland will also limit annual Medicare per capita hospital cost growth to a rate lower than the national annual per capita growth rate per year for 2015-2018. Moreover, the Maryland system may serve as a model for other states interested in developing all-payer payment systems. Under this model, Medicare is estimated to save at least $330 million over the next five years. This opportunity is available through the authority of the Innovation Center, which was created by the Affordable Care Act to test to payment and service delivery models.
Under the terms of the Maryland All-Payer Model:
- Maryland will agree to permanently shift away from its current statutory waiver, which is based on Medicare payment per inpatient admission, in exchange for the new Innovation Center model based on Medicare per capita total hospital cost growth.
- This model will require Maryland to generate $330 million in Medicare savings over a five year performance period, measured by comparing Maryland’s Medicare per capita total hospital cost growth to the national Medicare per capita total hospital cost growth.
- This model will require Maryland to limit its annual all-payer per capita total hospital cost growth to 3.58%, the 10-year compound annual growth rate in per capita gross state product.
- Maryland will shift virtually all of its hospital revenue over the five year performance period into global payment models.
- Maryland will achieve a number of quality targets designed to promote better care, better health and lower costs. Under the model, the quality of care for Maryland residents, including Medicare, Medicaid, and CHIP beneficiaries will improve as measured by hospital quality and population health measures.
- Readmissions: Maryland will commit to reducing its aggregate Medicare 30-day unadjusted all-cause, all-site hospital readmission rate in Maryland to the national Medicare 30-day unadjusted all-cause, all-site readmissions rate over five years.
- Hospital Acquired Conditions: Maryland currently operates a program that measures 3M’s 65 Potentially Preventable Conditions. Under this model, Maryland will achieve an annual aggregate reduction of 6.89% in the 65 PPCs over five years for a cumulative reduction of 30%.
- Population Health: Maryland will submit an annual report demonstrating its performance along various population health measures.
- If Maryland fails during the five-year performance period of the model, Maryland hospitals will transition over two years to the national Medicare payment systems.
- Before the start of the fourth year of the model, Maryland will develop a proposal for a new model based on a Medicare total per capita cost of care test to begin no later than after the end of the five year performance period.
If you look below you see what has been happening in Maryland is now being extended across the US under the Affordable Care Act. The idea of handing a lump sum to a health system corporation and then tell them to make it work will create this block granting that has been happening for Medicaid unofficially for years but now it will happen to Medicare.
The example above where funds for Medicaid were used to shovel a disabled or seniors walk because it is a safety and health issue is a block grant for Medicaid. In that case it was a good use of funds. What Maryland All-Payer does is allow these same conditions except a bunch of corporations are going to decide how those Medicare and Medicaid funds can be spent so the money comes back to them in profit. Shoveling sidewalks does not create profit for health corporations.
Obama appointed Bill Gate's Burwell to dismantle Federal Medicare and Medicaid and create these block grants because----
THAT IS WHAT REPUBLICANS HAVE TRIED FOR DECADES TO DO TO END MEDICARE AND MEDICAID......AND CLINTON NEO-LIBERALS ARE DOING IT FOR THEM BECAUSE-----THEY ARE REPUBLICANS.
Corporations are getting all of their wish lists in privatization because Clinton neo-liberals lie to Democratic voters about what policies mean----that paint them progressive no matter how repressive and regressive they are.
Medicaid Block Grants: A Zombie Idea With Lipstick in Texas
- Posted: 04/09/2013 5:02 pm EDT Updated: 06/09/2013 5:12 am EDT Huffington Post
- The latest proposal to block grant Medicaid in Texas is a terrible one for the state, its children, people with disabilities, and the elderly. Unfortunately, this bad idea, which just never seems to die, is once again being trotted out by Texas governor Rick Perry and his friends at the Texas Public Policy
Federal block grants are, by definition, an arbitrarily capped amount of federal funding that go to states in the form of a lump sum payment and fail to adjust for population growth, economic changes, public health crises, or natural disasters such as hurricanes, tornadoes, etc.
Thus, states with growing populations, such as Texas, or states often in the pathway of natural disasters, such as Texas, or states with a disproportionate share of low wage jobs, such as Texas, would be most negatively impacted by a federally-imposed block grant. As need increases due to any of these factors, block grants and federal assistance are, by definition, unresponsive and unhelpful. States would be left facing the full brunt of any calamity or crisis.
Looking to protect the states from the problems inherent in their block grant proposal, former Congressman Dick Armey and former State Rep. Arlene Wohlgemuth argued in a Politico op-ed on April Fools' Day, "Once a block grant is in place, Texas should fundamentally transform Medicaid from a defined benefit program to a defined contribution program for most eligibility groups. This would undoubtedly lead to cost savings and a more sustainable system over the long term. With skin in the game, and without an unlimited guarantee of state and federal funds, Medicaid enrollees would be more efficient in their use of health care and more engaged as consumers."
Put another way, states would not have to worry because any costs above the per-determined and federally-imposed arbitrary limit in the block grant would simply be shifted to low-income children, the disabled, and the elderly -- the very people that Medicaid is intended to protect. Asking low-income children, the disabled, and the elderly to put "skin the game" when need is increasing and support is capped will lead to one outcome: health care rationing.
Since block grants are arbitrarily capped, federal support would no longer adjust for changes in need or population and this would particularly be a disaster to Texas because it is one of the fastest growing states in the country. In fact, between 2000 and 2010, the number of children across the entire country increased by 1.9 million. But, in Texas alone, the number of children increased by 979,000 -- which is more than half of all the growth in the combined 50 states and the District of Columbia.
Moreover, since block grants fail to adjust appropriately for changes in need, current inequities and disparities are permanently locked into place and often expand. For Texas, which already starts with the 2nd highest uninsured rate for children in the country, the situation would get worse with the federal government cutting back and capping its support to Texas despite its rapidly growing population.
Underscoring this very problem, proponents of Medicaid block grants, such as the Texas-based National Center for Policy Analysis (NCPA), often cite the Temporary Assistance for Needy Families (TANF) block grant as a model for Medicaid "reform."
However, when TANF was converted to a block grant structure in 1996, Texas initially received just 31 percent of the national average in the amount of federal support per child in poverty. Rightfully so, the state was deeply concerned the block grant would lock in this inequity forever. Consequently, Texas Senator Kay Bailey Hutchison attempted to negotiate a more favorable formula change to help Texas. However, since block grants are set at an arbitrarily capped amount, any increase for Texas would led to reductions to other states so she was unsuccessful. Instead, to get her support, small Supplemental Grants were approved with the intent of reducing the inequities among states.
However, population growth quickly outstripped the small adjustment for Texas. Even worse, the Supplemental Grants were allowed to expire in 2011. As a result, today the states receive the same level of federal TANF funding they initially received in 1996 without any adjustments for population or economic changes. As a result, inequities have increased and Texas now receives less than 26 percent of the average level of federal spending per child in poverty. In fact, in 2012, Texas received just $294 per child in poverty from the federal TANF block grant compared to the $2,782 per child in poverty that New York received.
For Texas, block grants only make sense if you think that the children of New York deserve 9.5 times more federal support per child than what Texas receives for its children and think that disparity should also increase over time, as it has in TANF. Although I doubt that any Texan would approve of that incredible and growing disparity in federal funding, that would be the "pig in the poke" that Texas would be buying into if it agreed to a Medicaid block grant as touted by TPPF and NCPA.
Incredibly, TPPF clearly recognizes the inherent unfairness in such block grant formulas. As they acknowledge in their ironically-named report Save Texas Medicaid: A Proposal for Reform, "Determining the amount of the block grant based on historical funding presents a number of inequalities. Medicaid programs vary between the states, such that states with higher health care costs get more federal funding. In addition, some states have negotiated more favorable waiver arrangements than others, and Disproportionate Share Hospital (DSH) payments reflect historical use rather than rational policy choices."
Again, for Texas, a block grant would lock in and exacerbate those inequities. So, how would TPPF address this issue that they recognize is a problem? They would not. As the report reads, "Nonetheless, basing the initial block grant amount on historical spending is the most acceptable method because it represents the political status quo."
Interestingly, the solution to this inequity in their "reform proposal" is to adhere to the "political status quo" even if this "solution" is detrimental to Texans and reflects "historical use rather than rational policy choices." At least TPPF admits it is not rational.
However, in addition to being really poor policy, it is also poor politics. In fact, with respect to the politics of cutting and capping health coverage to children, former State Rep. Arlene Wohlgemuth should know better after having led the effort in the Texas Legislature to cut 147,000 children off of coverage in the Children's Health Insurance Program (CHIP). Despite beginning her subsequent 2004 political race for Congress with a lead in the polls, Wohlgemuth was defeated by Rep. Chet Edwards after he ran a devastating ad about the impact of Wohlgemuth's efforts to slash children's health coverage.
In a country as wealthy as ours, with the best medical care in the world if you can afford it, the American people do not think we should be not be threatening and rationing the health care of our children, seniors, and people with disabilities. Medicaid provides long-term care to millions of seniors, helps Americans with disabilities live independently, and enables millions of children to see a doctor. In fact, a Bloomberg national poll found that over three-quarters of the American public oppose cutting Medicaid and that it is the least popular option of all for deficit reduction.
In short, block granting Medicaid is a poorly conceived and arbitrary form of health rationing that in opposed by the American people and has been defeated on a bipartisan basis time-and-time again. Putting a new picture on the cover of this latest proposal does not change that fact. As former Texas governor Ann Richards would say, "You can put lipstick on a pig, but it is still a pig."
Rather than, once again, trotting this zombie idea to ration the health care of others: politicians (both current and former) should test the idea on themselves. Medicaid block grant proponents should first agree to cap and limit their own government insurance coverage. After such an experiment, they can then let us know whether they still consider health insurance for seniors, children, and people with disabilities should be rationed.