Before looking at the individual elements of Maryland's 'single-payer' being played as a progressive inclusive model for health care......I will take another day to look locally at Baltimore and its health care environment to show where the goal of Maryland's health model will go.
I have posted before that citizens in Baltimore are actually fearful of Johns Hopkins because of a belief that Hopkins is treating people as human capital-----profiteering from bodies. Now, since we have no oversight and accountability of health care in Baltimore-----and since the level of abuse and exploitation of the poor in Baltimore is extreme----I tend to believe Baltimore citizens that say they experience this attack on their physical bodies. Hopkins has operated in Baltimore as it would overseas because it has been living the Trans Pacific Trade Pact version of another US Constitution----one that is rewritten with no rights for people as citizens. That is why it fleeces, exploits, and jukes the stats at will. It is because Clinton embraced the Federalism Act as Executive Order as does Obama as any good Republican would----that Hopkins can do this with no Federal oversight.
THIS FEAR OF HEALTH INDUSTRY ABUSE WILL EXPLODE IF WE ALLOW TPP AND THE DISMANTLING OF OUR FEDERAL PUBLIC HEALTH TO CONTINUE. THIS IS NOT HYPERBOLE----IT IS TRUTH TO POWER.
As we see below the problem with health care costs IS HEALTH INDUSTRY FRAUD AND PROFITEERING----and as we see the Affordable Care Act unfold we see it simply creates the environment for fraud and profiteering to soar with the dismantlement of the one policy tool meant to keep health costs controlled-----A FEDERAL PUBLIC HEALTH PROGRAM MEDICARE AND MEDICAID. These programs were not only about helping the poor and seniors stay healthy----these programs keep private health industry prices and profit in check and this is why Republicans and Clinton neo-liberals want it gone----unchecked global profit-----whatever the market will bear.
So, Expanded and Improved Medicare for All----IT IS NOT SOCIALIST MY REPUBLICAN AND CONSERVATIVE DEMOCRATIC FRIENDS ----is the only way to keep costs in check and have the American people having access to common medical treatments. We are not talking concierge personal medicine---we are talking about the same basic care Americans have had for most of the 20th century.
Published on Monday, July 20, 2015 by Common Dreams
Private Health Care as an Act of Terrorism
byPaul Buchheit
Americans are being cheated by a medical system that favors profits over health and wellbeing. But things are even worse than that. (Photo: MilitaryHealth/flickr/cc)
The FBI defines terrorism as "Acts dangerous to human life...intended to intimidate or coerce a civilian population." Much of the behavior of our current health care system meets that definition. The facts show intention on the part of corporations to intimidate the population by using market strategies to charge whatever they like for their medical products and services, and an effort to coerce the public into accepting the current system as the only option.
The Average American Family Pays $4,000 for Medical Fraud and Subsidies
Medical billing fraud is estimated at 10 percent of all health care, or about $270 billion, while patent monopolies raise the price of prescription drugs by another $270 billion a year. Combined, this represents an astonishing annual cost of over $4,000 to an average American household. As The Atlantic puts it, "The people most likely to bilk the system are doctors and medical providers, not 'welfare queens.'"
Intimidation by Outrageous Markups
In a recent analysis of 50 hospitals (49 for-profit) with the highest charge-to-cost ratios in 2012, the average markup was 1,000 percent, which means that a procedure costing a hospital $100 is marked up to $1,000 for us.
Some of the markups test the limits of sanity: an 80-cent needle for $143.25 (a 17,000 percent markup). A 25-cent IUD device for $1,000. A blood test that costs $10 in one hospital and $10,000 in another.
A Johns Hopkins professor explained, "They are marking up the prices because no one is telling them they can’t."
Cheating and Coercion
Pharmaceutical companies have successfully lobbied Congress to keep Medicare from bargaining for lower drug prices. Americans are further cheated when corporations pay off generic drug manufacturers to delay entry of their products into the market, thereby forcing consumers to pay the highest prices for medicine.
We're cheated again by certificate-of-need laws, which force many patients to accept established money-making procedures while denying access to modern technologies such as virtual colonoscopies.
And cheated yet again when the doctors we trust accept payoffs from pharmaceutical companies to promote the most expensive products.
And, like the hospitals, corporations are fleecing the public with unfathomable markups. After Gilead Sciences was criticized for charging $1,000 for a hepatitis pill that costs $10 in Egypt, the company responded by introducing a new pill that costs $1,350.
The Terror of Poverty Without Health Care
Uninsurance can be deadly. Low-income minorities are least likely to have coverage, and the resulting financial stress, as documented by over 200 studies, leads to sickness and early death. Over 40 percent of uninsured adults of color would be eligible for Medicaid if the program were adopted by all states.
But it's not just the uninsured who feel the terror of unattainable health care. About half of privately insured Americans report experiencing financial hardship as a result of health care costs, and nearly half (43 percent) of sick Americans skipped doctor's visits and/or medication purchases in 2012 because of excessive costs. Even though with Obamacare the uninsured rate has dropped by nearly a third since 2013, the average deductible has more than doubled in just eight years, from under $600 to over $1,200, in large part due to corporate austerity measures. Many Americans can't afford this. A recent Bankrate poll found that almost two-thirds of Americans didn't have savings available to cover a$1,000 emergency room visit.
The Best Medical Care in the World -- For the Wealthy
Wealth promotes health. Super wealth buys an emergency room for the mansion or yacht or private plane, equipped with scanners, ultrasounds, x-ray machines, and blood analyzers. Or, if a hospital stay is needed, one fine option is a$2,400 suite with a butler in the hospital's penthouse.
Not all of "concierge medicine" is so extravagant. Basic signup fees range from $1,500 to $25,000 per year, with premium memberships offering unrestricted online access to a doctor, although with extra charges for face-to-face services. It's out of the question for almost all of us.
Yet with a farcical display of self-congratulatory capitalist trickle-down rationalization, Forbes proclaims that "these elite concierge medical practices are trailblazing methodologies and technologies that will, in time, be available to everyone."
Little chance with a privatized system. The reality is that being sick and having nowhere to turn is terrorizing far too many Americans.
This work is licensed under a Creative Commons Attribution-Share Alike 3.0 License Paul Buchheit is a college teacher, an active member of US Uncut Chicago, founder and developer of social justice and educational websites (UsAgainstGreed.org, PayUpNow.org, RappingHistory.org), and the editor and main author of "American Wars: Illusions and Realities" (Clarity Press). He can be reached at paul@UsAgainstGreed.org.
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Maryland is so geared to assure that all public health dies----we even have a separate health system that would be public only it is corporate non-profit and Hopkins with Beilenson as its director runs these non-profits that will become Medicaid for All.
EVERGREEN REPLACES OUR FEDERAL HEALTH PROGRAMS AND WILL MAKE SURE THAT ANY MEDICARE AND MEDICAID FUNDS WILL BE SPENT FOR PROFIT AND NOT PEOPLE.
Below you see why Maryland was first out the door to sign up for these Medicaid funds and believe me-----other Republican states doing the same for the same reason-----THEY TAKE THESE FEDERAL FUNDS AND THEN MISALLOCATE THEM. There is no state that misallocates Federal, state, and local funds better than Maryland. So, this drive of Obama's and Congressional neo-liberals to sound progressive in allocating these funds to Medicaid -----which we all know the Federal subsidy will end with this coming bond market economic crash-----are funds that will be directed in building the structures for global health systems----and not for Medicaid patient access.
Now, think about how in Maryland most of the current health system signup comes from people signing on as Medicaid plan and think how all those funds have almost no oversight and accountability-----Maryland does not even know how to build this because it does not require any oversight in any government function. This is why when Baltimore or Maryland is tied to a Federal funding that may actually be audited----IT ALWAYS FAILS.
What Maryland does with those Medicaid funds is place them in that health care pool and VOILA-----they disappear. Same with Medicare as Maryland was allowed to be the only state in the nation exempted from Federal Medicare oversight these few decades and as we all know-----there is no oversight of Medicare funds. This is why Maryland will be found one of the biggest FRAUDSTERS OF OUR FEDERAL MEDICARE AND MEDICAID PROGRAMS and as such we can go to Baltimore City to recover billions of dollars for Expanded and Improved Medicare for All.
Maryland Misallocated Millions to Establishment Grants for a Health Insurance Marketplace
The Maryland Department of Health and Mental Hygiene (State agency) did not allocate costs to its establishment grants and Medicaid in accordance with Federal requirements, the terms and conditions of the establishment grants, and its Cost Allocation Plan (CAP). The State agency allocated a total of $76.6 million to its establishment grants on the basis of a cost allocation methodology that (1) did not prospectively use updated or better data when available and (2) included a "material defect." As a result, the State agency misallocated $28.4 million in costs to the establishment grants instead of the Medicaid program.
The State agency misallocated these costs because it did not have adequate internal controls to ensure the proper allocation of costs.
We recommend that the State agency (1) refund $15.9 million to the Centers for Medicare & Medicaid Services (CMS) that was misallocated to the cooperative agreements because it did not prospectively use updated actual enrollment data; (2) refund $12.5 million to CMS that was misallocated to the establishment grants using a methodology that included a material defect; (3) immediately amend the CAP and the Advance Planning Document for the period July 1 through December 31, 2014, so that allocated costs correspond to the relative benefits received; (4) develop a written policy that explains how to calculate cost allocations and that emphasizes the necessity to use updated and actual data; and (5) oversee operations to ensure the identification and correction of enrollment projection errors, the use of better or updated enrollment data, and the application of these data to allocate costs.
In written comments on our draft report, the State agency concurred with recommendations four and five and said it will develop a written cost allocation policy and implement steps to oversee operations effectively. The State agency did not concur with the first three of our recommendations.
Copies can also be obtained by contacting the Office of Public Affairs at Public.Affairs@oig.hhs.gov.
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Below you see what is widespread in Baltimore-----citizens having benefits but not knowing it because there is no system of notifying a public especially with frequent housing changes. So, we have a low-income tax break in Baltimore where most of the funds remain unclaimed because citizens do not know they have the tax break. This is true of health care in Baltimore. Citizens simply go to a clinic and get what care they can and never know what they are supposed to receive according to Federal guidelines. They may not even know they are on Medicaid. Undercounting Medicaid enrollment is important because----if a citizen was determined to be uninsured before this health care reform-----the Federal government sent in more Federal funds to hospitals to cover this uninsured status. Juking the stats means that Maryland hospitals were claiming to be treating citizens as uninsured when in fact they qualified as Medicaid patients.
So, the Federal government sees a Maryland citizen as eligible for Medicaid and sends Maryland those funds-----but the Maryland citizen does not know this and is reported as uninsured-----giving double Federal money. Think how this was done especially in southern Republican states that do not see giving Federal public health care to citizens a priority and you see how these Federal programs were milked for funding. The mentality of milking Federal agencies with fraud in this case mirrors the milking of the FHA during the subprime mortgage frauds----if you have politicians steeped in criminal behavior------they juke the stats and steal Federal funding and then distribute it to corporate profit----in Baltimore's case this would have come to Johns Hopkins Medical system and UMMS.
These frauds have operated since Reagan/Clinton when dismantling of Federal agencies of oversight opened the gate to systemic corporate frauds from our Federal Treasury and Public Trusts.
Undercounting Medicaid Enrollment in Maryland:
Testing the Accuracy of the Current Population Survey
Todd Eberly Mary Beth Pohl Stacey Davis
Received: 29 May 2007/Accepted: 27 December 2007/Published online: 30 April 2008
? Springer Science+Business Media B.V. 2008
Abstract
The U.S. Census Bureau's Current Population Survey is the most commonly cited source for estimates of the insurance status of Americans, but there are concerns that the data may undercount participation in public programs such as Medicaid. Such a Medicaid undercount may result from survey respondents not acknowledging Medicaid coverage because they are unaware that they are enrolled in Medicaid, because they have not recently received health services, due to the stigma associated with receiving public assistance programs, or due to simple recall bias. This paper estimates the extent to which the Current Population Survey undercounts Medicaid participation in a single mid-Atlantic state, Maryland. We administered the Current Population Survey questionnaire to a random selection of known Medicaid participants. We find evidence that the Current Population Survey significantly undercounts Medicaid participation in Maryland and that much of the undercount could be corrected if the survey better identified the Maryland Medicaid program. We also find that recall bias may contribute to the undercount as well.
There was no indication that stigma contributed to any undercount. Though not an aim of this study,w e find that the Medicaid undercount may contribute to an over count of the number of uninsured.
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The push to get people onto Medicaid these few years has nothing to do with helping people----it is again the Federal funding that is being sent to states for each Medicaid patient. Since the Federal government has ended the War on Poverty public health subsidy for uninsured citizens with austerity------that uninsured payment to hospitals shown above-----it no longer is beneficial to skew Medicaid data. Hospitals in Maryland mostly do not allow uninsured patients to enter even through an emergency room anymore. If you read any article on the availability of doctors you will see there are very few Medicaid doctors-----and in Baltimore where Medicaid would need to cover most citizens-----the number of doctors taking Medicaid is super-small. So these Medicaid patients are insured with nowhere to go.
THAT IS HOW A CORPORATE STATE MILKS FEDERAL PROGRAMS AND MAKES SURE THOSE NEEDING IT DON'T RECEIVE IT. THAT MONEY IS SUCKED UP BY THE LIKES OF JOHNS HOPKINS WHICH CONTROLS MUCH OF THE HEALTH CARE FOR THE POOR IN BALTIMORE AND THIS IS WHY----NOT BECAUSE IT CARES FOR THE POOR.
The Maryland health system has most of its new enrollees so far listed as Medicaid probably because Maryland has one of the most expensive premium/co-pay/deductible costs in the nation. At the same time, those Medicaid patients are sent to a non-profit health insurance plan which they intend to take over the Federal Medicaid and Medicare when they end these programs after this coming economic crash.....it looks like Obama is setting 2020 for the closing of these Federal programs as that will coincide with Trans Pacific Trade Pact being installed.
MEANWHILE, CLINTON NEO-LIBERALS ARE ALL PRETENDING THE AFFORDABLE CARE ACT IS ABOUT HEALTH CARE FOR ALL-----
SEE WHY HAVING A BALTIMORE CITY MEDICARE AND MEDICAID OVERSIGHT AND ACCOUNTABILITY OFFICE IS CRITICAL????? THE AMOUNT OF MONEY SAVED FROM JUST FRAUD AND PROFITEERING WILL ALLOW ACCESS FOR ALL TO ALL THE HEALTH CARE THEY NEED.
Maryland Medicaid enrollment surges past projections
Jan 30, 2014, 10:17am EST
Sarah Gantz ReporterBaltimore Business Journal Sarah Gantz ReporterBaltimore Business Journal
Crates filled with Medicaid packets line the walls at Health Care for the Homeless in… more
While the state is struggling to get Marylanders enrolled in private health plans through the new health exchange, Medicaid enrollment has already surpassed fiscal year-end projections.
As of this week, a total of 121,000 Marylanders have enrolled in Medicaid, beating out projected enrollment of 110,000 people by the end of June. Charles Milligan, the state’s deputy health secretary for Medicaid, credits the high enrollment totals to early preparation. A majority of the new Medicaid enrollees did not have to navigate the troubled state exchange to sign up because they were part of a program that automatically transferred members to Medicaid Jan. 1.
“It’s significant for Medicaid participants themselves because it gives them not only insurance and access to health care, but peace of mind about potential economic stress for people worried about paying for care out of pocket,” Milligan said.
Meanwhile, the state will likely fall short of its goal to enroll 150,000 Marylanders in private health plans through the exchange. Roughly 25,000 people have enrolled so far, according to a Jan. 24 report by the exchange.
About 95,000 of the new Medicaid enrollees were transferred automatically from the state’s Primary Adult Care (PAC) program — a limited coverage Medicaid plan for adults.
Unlike anyone looking to sign up for Medicaid or federally subsidized private insurance now, the 95,000 people who came to Medicaid through PAC did not have to navigate the exchange. Their PAC policies were automatically upgraded to full Medicaid plans.
Milligan said his department started in January 2013 to beef up outreach and enrollment for that program, knowing that those individuals could automatically be moved to a full Medicaid plan at the beginning of 2014.
“Part of the reality is that the recession has dragged on the economy longer than some of us anticipated,” Milligan said. “That’s resulted in the fact that there might be more Medicaid-eligible people than forecast.”
Milligan said the state has not yet updated its year-end projections for Medicaid enrollment.
Higher-than-expected Medicaid enrollment could have an impact on the state’s Medicaid budget. Most of the new enrollees will be covered by federal funds that were made available to state that agreed to expand eligibility for the publicly funded health program. But a small portion of enrollees will be paid for by the state, though Milligan said he did not know yet what additional cost this would be for the state.
The growth in Medicaid is also meaningful for hospitals and insurers. In Maryland, money to cover the hospital costs of uninsured residents is worked into the rates insurers pay (insurers pass on the cost to consumers). With fewer uninsured residents, the amount worked into rates for so-called uncompensated care will likely decrease.
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The reason some states were allowed to opt out of Medicaid expansion was that Obama embraced by Executive Order the Federalism Act -----that means Obama will not enforce Federal laws that cost states money----and that is all progressive Constitutional laws. So, as Clinton neo-liberals try to shame Republican states for failing to sign on to Medicaid-----it was Clinton and Obama who signed on to this Republican refusal to enforce Federal laws that would have required Medicaid expansion be allowed.
Remember, the goal of ACA is to end all Federal public health because Trans Pacific Trade Pact does not allow public subsidy that takes away from global corporate profits. So, just think what this game is-----people once fully insured in good private corporate plans or public sector health plans that are being axed are now being moved onto Medicaid with this Federal funding for a few years and then VOILA----
ALL THAT FEDERAL FUNDING FOR MEDICAID ENDS BECAUSE OF THE ECONOMIC CRASH FROM THE COLLAPSING BOND MARKET.
So, Medicaid having already been slashed of funding back in 2010 will be slashed again as Medicaid no longer looks like Medicaid and while more and more Americans are being pushed to Medicaid.
THIS IS HOW YOU END A FEDERAL PUBLIC HEALTH PLAN THAT IS A CONSTITUTIONAL RIGHT----IT IS SO DEFUNDED AND OUTSOURCED AS TO HAVE NO ONE WANTING TO USE IT.
That is the goal-----and that is a Clinton neo-liberal for you!!!!
Keep in mind as you read this the level of health industry fraud over just a few decades against Medicaid ----trillions of dollars that should be coming back and all that fraud ignored because we have Clinton neo-liberals instead of Democrats in office.
As Number of Medicaid Patients Goes Up, Their Benefits Are About to Drop
By ROBERT PEARJUNE 15, 2011
WASHINGTON — The Obama administration injected billions of dollars into Medicaid, the nation’s low-income health program, as the recession deepened two years ago. The money runs out at the end of this month, and benefits are being cut for millions of people, even though unemployment has increased.
From New Jersey to California, state officials are bracing for the end to more than $90 billion in federal largess specifically designated for Medicaid. To hold down costs, states are cutting Medicaid payments to doctors and hospitals, limiting benefits for Medicaid recipients, reducing the scope of covered services, requiring beneficiaries to pay larger co-payments and expanding the use of managed care.
As a result, costs can be expected to rise in other parts of the health care system. Cuts in Medicaid payments to doctors, for example, make it less likely that they will accept Medicaid patients and more likely that people will turn to hospital emergency rooms for care. Hospitals and other health care providers often try to make up for the loss of Medicaid revenue by increasing charges to other patients, including those with private insurance, experts say.
Neither the White House nor Congress has tried to extend the extra federal financing for Medicaid, even though the number of beneficiaries is higher now than when Congress approved the aid as part of an economic recovery package in February 2009.
The Congressional Budget Office estimates that federal Medicaid spending will decline in 2012 for only the second time in the 46-year history of the program. But states say they will have to have to spend more on Medicaid as they struggle to make up for the loss of federal money.
State officials say they are resigned to the loss of the extra federal matching payments, given the climate in Congress, where deficit reduction is a paramount goal.
“We all see the reality of what’s going on in Congress,” said Mark W. Rupp, director of the Washington office of Gov. Christine Gregoire of Washington State, a Democrat who is chairwoman of the National Governors Association. “It’s more about cutting than spending. Why put a lot of effort into something that did not seem likely to have a positive outcome? It would have been fairly futile.”
Although Medicaid provides health insurance to one in five Americans at some point in a year, it is more vulnerable to cuts than Medicare and Social Security, which have broader political support.
“Medicaid is very much on the chopping block,” said Senator John D. Rockefeller IV, Democrat of West Virginia and chairman of the Senate Finance Subcommittee on Health Care. “Seniors vote. But if you are poor and disabled, you might not vote, and if you are a child, you do not vote — that’s a lot of Medicaid’s population. They don’t have money to do lobbying.”
Medicaid is financed jointly by the federal government and the states, with the federal government paying a larger share in poorer states like Mississippi and West Virginia and a smaller share in higher-income states like New York and Connecticut.
The aid ending next month increased the federal share of Medicaid spending in all states, with additional help for states where unemployment rates had risen sharply. The extra aid was scheduled to expire last December, but Congress extended it for six months at the urging of the White House and state officials.
The additional money pushed the average federal share of Medicaid spending nationwide to 67 percent. It will revert to 57 percent next month. The cutback in federal Medicaid money has put pressure on states to cut the budget for other programs, including education and social services.
Toby J. Douglas, director of the California Department of Health Care Services, said the federal Medicaid cut was causing “very consequential reductions in health care and other public programs.”
California is cutting Medicaid payments to doctors and many other providers by 10 percent; has established new co-payments for drugs, doctors’ services and hospital care; and will limit beneficiaries to seven doctor’s office visits a year unless a doctor certifies a need for more.
With 7.6 million Medicaid beneficiaries — 50 percent more than any other state — California faces bigger problems, but its response has been typical. A survey issued this month by the National Association of State Budget Officers found that 24 states were reducing Medicaid payments to providers, while 20 were limiting benefits in some way.
R. Andrew Allison, who is executive director of the Kansas Health Policy Authority and president of the National Association of Medicaid Directors, said Medicaid was gobbling up new revenues as states recovered slowly from the recession.
Kansas illustrates the predicament most states are facing. Federal Medicaid payments in Kansas are expected to decline by more than $250 million, or 13 percent, in the state’s new fiscal year, which starts July 1, Mr. Allison said. But the amount of state revenue spent on Medicaid is expected to increase by more than $300 million, or 39 percent.
New York has just imposed a cap on state Medicaid spending, with a separate limit for each sector like hospitals, nursing homes and managed care plans. Under a new state law, if it appears that the state share of Medicaid spending will exceed the cap, New York officials must devise and carry out a plan to reduce spending, by modifying benefits, provider payment rates or other features of the program.
“This is an enormous sea change for Medicaid,” said Jeffrey Gordon, a spokesman for the New York State Health Department.
Continue reading the main story Write A Comment In New Jersey, Gov. Chris Christie, a Republican, said, “Medicaid’s growth is out of control,” and he has proposed numerous changes “to fill in the hole created by the loss of over a billion dollars of federal stimulus money” for the program. He would tighten eligibility, reduce Medicaid payment rates for nursing homes, move older and disabled Medicaid recipients into managed care, and charge co-payments for medical day care services.
The New Jersey Legislature appears likely to accept some of the changes in a budget to be adopted this month.
Connecticut has avoided major cuts in Medicaid, but the State Legislature has set new limits on vision and dental coverage for adults.
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Below you see what will replace Medicare and Medicaid in Maryland and it is no coincidence that the head of this health exchange non-profit is a Johns Hopkins partner. As you see below they are moving Maryland's Veterans to this non-profit because the Veteran's Administration is being privatized and closed and Veteran's benefits are being defunded-----ergo all of the charity ads on TV.
The VA is a Federal health program that veterans paid for with service and as a Federal program will fall into these non-profit health insurance plans along with Medicaid and Medicare. Since Hopkins controls most of the health care in the Baltimore region it will use this format of non-profits to control all government funding to care for the poor, seniors, disabled, and veterans.
This non-profit format will replace all public health programs at the same time private insurance corporations go global and become so expensive that most Americans will not be able to afford them and be pushed into these non-profit plans. What will this ghettoized health insurance look like? As I said years ago-----it will be the same kind of preventative clinic care that people in third world nations receive..
THIS IS TO WHERE OVER 80% OF MARYLANDERS WILL GO UNDER MARYLAND'S PRIVATIZED SINGLE-PAYER-----
See why Expanded and Improved Medicare for All is better and we need to start building the platform in Baltimore right now----the 2016 election should have all Democratic primary candidates shouting how they are going to install Medicare for All. In Maryland, Clinton neo-liberals and Baltimore's neo-conservatives running as Democrats are still trying to pretend the Affordable Care Act was progressive.
Beilenson was at Hopkins as all of Baltimore's VA functions were dismantled and doctors with the VA courted to Hopkins health tourism.
Improving access for Veterans by giving them access to preventative care only!!!!! HOW SPECIAL!!!
Maryland Politics
Maryland veterans waiting for primary care have a new option: Evergreen Health Care
Peter Beilenson of Evergreen Health Care. (Ricky Carioti/The Washington Post) By Jenna Johnson September 1, 2014 Veterans who have been waiting for months to see a primary-care doctor through the Veterans Affairs Maryland Health Care System can visit one of the four Evergreen Health Care facilities that are affiliated with the state’s new health insurance co-op.
Maryland VA officials signed a contract with Evergreen in August to spend up to $485,000 for ongoing primary care for as many as 1,000 veterans. The contract could change based on need.
Adam M. Robinson Jr., VA Maryland Health Care System chief of staff, said in a statement Thursday that the “partnership is a major component of our aggressive action plan to improve patient access.”
#pmad-01-frame { display: inline-block; width: 300px; height: 90px; } VA medical systems are required to see new patients within 14 days after their paperwork is accepted and returning patients within 14 to 30 days of an appointment request. Some states have been accused of tampering with their scheduling to hide backlogs.
An audit of the Maryland VA system this year found no improper scheduling, according to the statement, but discovered that the system was not seeing new patients quickly enough.
Maryland veterans will have the choice of continuing to wait to see a primary-care doctor through VA or seeing a doctor at one of Evergreen’s health facilities in Baltimore, Columbia, White Marsh or Greenbelt.
“It’s totally up to the veteran,” said Peter Beilenson, chairman of the board of Evergreen Health Care and founder of its affiliated insurance company.
Veterans can return for up to six visits a year, Beilenson said, and will be referred back to VA for more serious problems that require a specialist. In addition to general primary care, Evergreen can provide screenings, wellness programs and counseling.
The partnership means a rush of new patients for the Evergreen clinics, where business has been much slower than expected because not enough people have signed up for health insurance through Evergreen Health Co-op, a start-up made possible by the Affordable Care Act.
About two dozen such nonprofit co-ops are operating across the country, with varying degrees of success. They aim to shake up the insurance market by offering low-priced, high-perks plans that can bring down health-care costs.
#pmad-02-frame { display: inline-block; width: 300px; height: 90px; } Unlike other co-ops, Evergreen has affiliated health-care centers for members that focus on preventive care and general wellness.
Evergreen planned to find its customers on Maryland’s online health-insurance marketplace, at which plans from four carriers would be clearly detailed. Beilenson thought Evergreen easily could enroll 10,000 people in the first year.
But the state Web site crashed the day it debuted last year, struggled through the six-month-long enrollment period and is being rebuilt before the next open-enrollment period starts Nov. 15.
Maryland enrolled 72,000 people in private plans, roughly half of the state’s original estimate. Of those, 94 percent chose a plan from CareFirst, a major Maryland-based insurance carrier that often had plans with the lowest premiums.
For the second open enrollment, CareFirst will increase its premiums by about 10 percent to 16 percent, while the other three carriers will decrease premiums. Evergreen’s rates will be about 10 percent lower.
“They grossly underpriced the market on purpose,” Beilenson said of CareFirst in its first year on the exchange. “We’re going to be much more competitive.”
Evergreen has found success in selling coverage to small groups and businesses, offering lower prices and promising to keep those prices for two years. The co-op has 3,600 members and hopes to have 6,000 by the end of the year, Beilenson said.
When reports of long waits for veterans surfaced this year, Beilenson reached out to Maryland officials and offered to treat their patients in his health centers. He said more than 700 veterans in Maryland have been waiting for at least 90 days for appointments.
Evergreen saw its first veteran Friday morning in Columbia, he said, and plans to see many more on Tuesday.
I have posted before that citizens in Baltimore are actually fearful of Johns Hopkins because of a belief that Hopkins is treating people as human capital-----profiteering from bodies. Now, since we have no oversight and accountability of health care in Baltimore-----and since the level of abuse and exploitation of the poor in Baltimore is extreme----I tend to believe Baltimore citizens that say they experience this attack on their physical bodies. Hopkins has operated in Baltimore as it would overseas because it has been living the Trans Pacific Trade Pact version of another US Constitution----one that is rewritten with no rights for people as citizens. That is why it fleeces, exploits, and jukes the stats at will. It is because Clinton embraced the Federalism Act as Executive Order as does Obama as any good Republican would----that Hopkins can do this with no Federal oversight.
THIS FEAR OF HEALTH INDUSTRY ABUSE WILL EXPLODE IF WE ALLOW TPP AND THE DISMANTLING OF OUR FEDERAL PUBLIC HEALTH TO CONTINUE. THIS IS NOT HYPERBOLE----IT IS TRUTH TO POWER.
As we see below the problem with health care costs IS HEALTH INDUSTRY FRAUD AND PROFITEERING----and as we see the Affordable Care Act unfold we see it simply creates the environment for fraud and profiteering to soar with the dismantlement of the one policy tool meant to keep health costs controlled-----A FEDERAL PUBLIC HEALTH PROGRAM MEDICARE AND MEDICAID. These programs were not only about helping the poor and seniors stay healthy----these programs keep private health industry prices and profit in check and this is why Republicans and Clinton neo-liberals want it gone----unchecked global profit-----whatever the market will bear.
So, Expanded and Improved Medicare for All----IT IS NOT SOCIALIST MY REPUBLICAN AND CONSERVATIVE DEMOCRATIC FRIENDS ----is the only way to keep costs in check and have the American people having access to common medical treatments. We are not talking concierge personal medicine---we are talking about the same basic care Americans have had for most of the 20th century.
Published on Monday, July 20, 2015 by Common Dreams
Private Health Care as an Act of Terrorism
byPaul Buchheit
Americans are being cheated by a medical system that favors profits over health and wellbeing. But things are even worse than that. (Photo: MilitaryHealth/flickr/cc)
The FBI defines terrorism as "Acts dangerous to human life...intended to intimidate or coerce a civilian population." Much of the behavior of our current health care system meets that definition. The facts show intention on the part of corporations to intimidate the population by using market strategies to charge whatever they like for their medical products and services, and an effort to coerce the public into accepting the current system as the only option.
The Average American Family Pays $4,000 for Medical Fraud and Subsidies
Medical billing fraud is estimated at 10 percent of all health care, or about $270 billion, while patent monopolies raise the price of prescription drugs by another $270 billion a year. Combined, this represents an astonishing annual cost of over $4,000 to an average American household. As The Atlantic puts it, "The people most likely to bilk the system are doctors and medical providers, not 'welfare queens.'"
Intimidation by Outrageous Markups
In a recent analysis of 50 hospitals (49 for-profit) with the highest charge-to-cost ratios in 2012, the average markup was 1,000 percent, which means that a procedure costing a hospital $100 is marked up to $1,000 for us.
Some of the markups test the limits of sanity: an 80-cent needle for $143.25 (a 17,000 percent markup). A 25-cent IUD device for $1,000. A blood test that costs $10 in one hospital and $10,000 in another.
A Johns Hopkins professor explained, "They are marking up the prices because no one is telling them they can’t."
Cheating and Coercion
Pharmaceutical companies have successfully lobbied Congress to keep Medicare from bargaining for lower drug prices. Americans are further cheated when corporations pay off generic drug manufacturers to delay entry of their products into the market, thereby forcing consumers to pay the highest prices for medicine.
We're cheated again by certificate-of-need laws, which force many patients to accept established money-making procedures while denying access to modern technologies such as virtual colonoscopies.
And cheated yet again when the doctors we trust accept payoffs from pharmaceutical companies to promote the most expensive products.
And, like the hospitals, corporations are fleecing the public with unfathomable markups. After Gilead Sciences was criticized for charging $1,000 for a hepatitis pill that costs $10 in Egypt, the company responded by introducing a new pill that costs $1,350.
The Terror of Poverty Without Health Care
Uninsurance can be deadly. Low-income minorities are least likely to have coverage, and the resulting financial stress, as documented by over 200 studies, leads to sickness and early death. Over 40 percent of uninsured adults of color would be eligible for Medicaid if the program were adopted by all states.
But it's not just the uninsured who feel the terror of unattainable health care. About half of privately insured Americans report experiencing financial hardship as a result of health care costs, and nearly half (43 percent) of sick Americans skipped doctor's visits and/or medication purchases in 2012 because of excessive costs. Even though with Obamacare the uninsured rate has dropped by nearly a third since 2013, the average deductible has more than doubled in just eight years, from under $600 to over $1,200, in large part due to corporate austerity measures. Many Americans can't afford this. A recent Bankrate poll found that almost two-thirds of Americans didn't have savings available to cover a$1,000 emergency room visit.
The Best Medical Care in the World -- For the Wealthy
Wealth promotes health. Super wealth buys an emergency room for the mansion or yacht or private plane, equipped with scanners, ultrasounds, x-ray machines, and blood analyzers. Or, if a hospital stay is needed, one fine option is a$2,400 suite with a butler in the hospital's penthouse.
Not all of "concierge medicine" is so extravagant. Basic signup fees range from $1,500 to $25,000 per year, with premium memberships offering unrestricted online access to a doctor, although with extra charges for face-to-face services. It's out of the question for almost all of us.
Yet with a farcical display of self-congratulatory capitalist trickle-down rationalization, Forbes proclaims that "these elite concierge medical practices are trailblazing methodologies and technologies that will, in time, be available to everyone."
Little chance with a privatized system. The reality is that being sick and having nowhere to turn is terrorizing far too many Americans.
This work is licensed under a Creative Commons Attribution-Share Alike 3.0 License Paul Buchheit is a college teacher, an active member of US Uncut Chicago, founder and developer of social justice and educational websites (UsAgainstGreed.org, PayUpNow.org, RappingHistory.org), and the editor and main author of "American Wars: Illusions and Realities" (Clarity Press). He can be reached at paul@UsAgainstGreed.org.
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Maryland is so geared to assure that all public health dies----we even have a separate health system that would be public only it is corporate non-profit and Hopkins with Beilenson as its director runs these non-profits that will become Medicaid for All.
EVERGREEN REPLACES OUR FEDERAL HEALTH PROGRAMS AND WILL MAKE SURE THAT ANY MEDICARE AND MEDICAID FUNDS WILL BE SPENT FOR PROFIT AND NOT PEOPLE.
Below you see why Maryland was first out the door to sign up for these Medicaid funds and believe me-----other Republican states doing the same for the same reason-----THEY TAKE THESE FEDERAL FUNDS AND THEN MISALLOCATE THEM. There is no state that misallocates Federal, state, and local funds better than Maryland. So, this drive of Obama's and Congressional neo-liberals to sound progressive in allocating these funds to Medicaid -----which we all know the Federal subsidy will end with this coming bond market economic crash-----are funds that will be directed in building the structures for global health systems----and not for Medicaid patient access.
Now, think about how in Maryland most of the current health system signup comes from people signing on as Medicaid plan and think how all those funds have almost no oversight and accountability-----Maryland does not even know how to build this because it does not require any oversight in any government function. This is why when Baltimore or Maryland is tied to a Federal funding that may actually be audited----IT ALWAYS FAILS.
What Maryland does with those Medicaid funds is place them in that health care pool and VOILA-----they disappear. Same with Medicare as Maryland was allowed to be the only state in the nation exempted from Federal Medicare oversight these few decades and as we all know-----there is no oversight of Medicare funds. This is why Maryland will be found one of the biggest FRAUDSTERS OF OUR FEDERAL MEDICARE AND MEDICAID PROGRAMS and as such we can go to Baltimore City to recover billions of dollars for Expanded and Improved Medicare for All.
Maryland Misallocated Millions to Establishment Grants for a Health Insurance Marketplace
The Maryland Department of Health and Mental Hygiene (State agency) did not allocate costs to its establishment grants and Medicaid in accordance with Federal requirements, the terms and conditions of the establishment grants, and its Cost Allocation Plan (CAP). The State agency allocated a total of $76.6 million to its establishment grants on the basis of a cost allocation methodology that (1) did not prospectively use updated or better data when available and (2) included a "material defect." As a result, the State agency misallocated $28.4 million in costs to the establishment grants instead of the Medicaid program.
The State agency misallocated these costs because it did not have adequate internal controls to ensure the proper allocation of costs.
We recommend that the State agency (1) refund $15.9 million to the Centers for Medicare & Medicaid Services (CMS) that was misallocated to the cooperative agreements because it did not prospectively use updated actual enrollment data; (2) refund $12.5 million to CMS that was misallocated to the establishment grants using a methodology that included a material defect; (3) immediately amend the CAP and the Advance Planning Document for the period July 1 through December 31, 2014, so that allocated costs correspond to the relative benefits received; (4) develop a written policy that explains how to calculate cost allocations and that emphasizes the necessity to use updated and actual data; and (5) oversee operations to ensure the identification and correction of enrollment projection errors, the use of better or updated enrollment data, and the application of these data to allocate costs.
In written comments on our draft report, the State agency concurred with recommendations four and five and said it will develop a written cost allocation policy and implement steps to oversee operations effectively. The State agency did not concur with the first three of our recommendations.
Copies can also be obtained by contacting the Office of Public Affairs at Public.Affairs@oig.hhs.gov.
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Below you see what is widespread in Baltimore-----citizens having benefits but not knowing it because there is no system of notifying a public especially with frequent housing changes. So, we have a low-income tax break in Baltimore where most of the funds remain unclaimed because citizens do not know they have the tax break. This is true of health care in Baltimore. Citizens simply go to a clinic and get what care they can and never know what they are supposed to receive according to Federal guidelines. They may not even know they are on Medicaid. Undercounting Medicaid enrollment is important because----if a citizen was determined to be uninsured before this health care reform-----the Federal government sent in more Federal funds to hospitals to cover this uninsured status. Juking the stats means that Maryland hospitals were claiming to be treating citizens as uninsured when in fact they qualified as Medicaid patients.
So, the Federal government sees a Maryland citizen as eligible for Medicaid and sends Maryland those funds-----but the Maryland citizen does not know this and is reported as uninsured-----giving double Federal money. Think how this was done especially in southern Republican states that do not see giving Federal public health care to citizens a priority and you see how these Federal programs were milked for funding. The mentality of milking Federal agencies with fraud in this case mirrors the milking of the FHA during the subprime mortgage frauds----if you have politicians steeped in criminal behavior------they juke the stats and steal Federal funding and then distribute it to corporate profit----in Baltimore's case this would have come to Johns Hopkins Medical system and UMMS.
These frauds have operated since Reagan/Clinton when dismantling of Federal agencies of oversight opened the gate to systemic corporate frauds from our Federal Treasury and Public Trusts.
Undercounting Medicaid Enrollment in Maryland:
Testing the Accuracy of the Current Population Survey
Todd Eberly Mary Beth Pohl Stacey Davis
Received: 29 May 2007/Accepted: 27 December 2007/Published online: 30 April 2008
? Springer Science+Business Media B.V. 2008
Abstract
The U.S. Census Bureau's Current Population Survey is the most commonly cited source for estimates of the insurance status of Americans, but there are concerns that the data may undercount participation in public programs such as Medicaid. Such a Medicaid undercount may result from survey respondents not acknowledging Medicaid coverage because they are unaware that they are enrolled in Medicaid, because they have not recently received health services, due to the stigma associated with receiving public assistance programs, or due to simple recall bias. This paper estimates the extent to which the Current Population Survey undercounts Medicaid participation in a single mid-Atlantic state, Maryland. We administered the Current Population Survey questionnaire to a random selection of known Medicaid participants. We find evidence that the Current Population Survey significantly undercounts Medicaid participation in Maryland and that much of the undercount could be corrected if the survey better identified the Maryland Medicaid program. We also find that recall bias may contribute to the undercount as well.
There was no indication that stigma contributed to any undercount. Though not an aim of this study,w e find that the Medicaid undercount may contribute to an over count of the number of uninsured.
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The push to get people onto Medicaid these few years has nothing to do with helping people----it is again the Federal funding that is being sent to states for each Medicaid patient. Since the Federal government has ended the War on Poverty public health subsidy for uninsured citizens with austerity------that uninsured payment to hospitals shown above-----it no longer is beneficial to skew Medicaid data. Hospitals in Maryland mostly do not allow uninsured patients to enter even through an emergency room anymore. If you read any article on the availability of doctors you will see there are very few Medicaid doctors-----and in Baltimore where Medicaid would need to cover most citizens-----the number of doctors taking Medicaid is super-small. So these Medicaid patients are insured with nowhere to go.
THAT IS HOW A CORPORATE STATE MILKS FEDERAL PROGRAMS AND MAKES SURE THOSE NEEDING IT DON'T RECEIVE IT. THAT MONEY IS SUCKED UP BY THE LIKES OF JOHNS HOPKINS WHICH CONTROLS MUCH OF THE HEALTH CARE FOR THE POOR IN BALTIMORE AND THIS IS WHY----NOT BECAUSE IT CARES FOR THE POOR.
The Maryland health system has most of its new enrollees so far listed as Medicaid probably because Maryland has one of the most expensive premium/co-pay/deductible costs in the nation. At the same time, those Medicaid patients are sent to a non-profit health insurance plan which they intend to take over the Federal Medicaid and Medicare when they end these programs after this coming economic crash.....it looks like Obama is setting 2020 for the closing of these Federal programs as that will coincide with Trans Pacific Trade Pact being installed.
MEANWHILE, CLINTON NEO-LIBERALS ARE ALL PRETENDING THE AFFORDABLE CARE ACT IS ABOUT HEALTH CARE FOR ALL-----
SEE WHY HAVING A BALTIMORE CITY MEDICARE AND MEDICAID OVERSIGHT AND ACCOUNTABILITY OFFICE IS CRITICAL????? THE AMOUNT OF MONEY SAVED FROM JUST FRAUD AND PROFITEERING WILL ALLOW ACCESS FOR ALL TO ALL THE HEALTH CARE THEY NEED.
Maryland Medicaid enrollment surges past projections
Jan 30, 2014, 10:17am EST
Sarah Gantz ReporterBaltimore Business Journal Sarah Gantz ReporterBaltimore Business Journal
Crates filled with Medicaid packets line the walls at Health Care for the Homeless in… more
While the state is struggling to get Marylanders enrolled in private health plans through the new health exchange, Medicaid enrollment has already surpassed fiscal year-end projections.
As of this week, a total of 121,000 Marylanders have enrolled in Medicaid, beating out projected enrollment of 110,000 people by the end of June. Charles Milligan, the state’s deputy health secretary for Medicaid, credits the high enrollment totals to early preparation. A majority of the new Medicaid enrollees did not have to navigate the troubled state exchange to sign up because they were part of a program that automatically transferred members to Medicaid Jan. 1.
“It’s significant for Medicaid participants themselves because it gives them not only insurance and access to health care, but peace of mind about potential economic stress for people worried about paying for care out of pocket,” Milligan said.
Meanwhile, the state will likely fall short of its goal to enroll 150,000 Marylanders in private health plans through the exchange. Roughly 25,000 people have enrolled so far, according to a Jan. 24 report by the exchange.
About 95,000 of the new Medicaid enrollees were transferred automatically from the state’s Primary Adult Care (PAC) program — a limited coverage Medicaid plan for adults.
Unlike anyone looking to sign up for Medicaid or federally subsidized private insurance now, the 95,000 people who came to Medicaid through PAC did not have to navigate the exchange. Their PAC policies were automatically upgraded to full Medicaid plans.
Milligan said his department started in January 2013 to beef up outreach and enrollment for that program, knowing that those individuals could automatically be moved to a full Medicaid plan at the beginning of 2014.
“Part of the reality is that the recession has dragged on the economy longer than some of us anticipated,” Milligan said. “That’s resulted in the fact that there might be more Medicaid-eligible people than forecast.”
Milligan said the state has not yet updated its year-end projections for Medicaid enrollment.
Higher-than-expected Medicaid enrollment could have an impact on the state’s Medicaid budget. Most of the new enrollees will be covered by federal funds that were made available to state that agreed to expand eligibility for the publicly funded health program. But a small portion of enrollees will be paid for by the state, though Milligan said he did not know yet what additional cost this would be for the state.
The growth in Medicaid is also meaningful for hospitals and insurers. In Maryland, money to cover the hospital costs of uninsured residents is worked into the rates insurers pay (insurers pass on the cost to consumers). With fewer uninsured residents, the amount worked into rates for so-called uncompensated care will likely decrease.
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The reason some states were allowed to opt out of Medicaid expansion was that Obama embraced by Executive Order the Federalism Act -----that means Obama will not enforce Federal laws that cost states money----and that is all progressive Constitutional laws. So, as Clinton neo-liberals try to shame Republican states for failing to sign on to Medicaid-----it was Clinton and Obama who signed on to this Republican refusal to enforce Federal laws that would have required Medicaid expansion be allowed.
Remember, the goal of ACA is to end all Federal public health because Trans Pacific Trade Pact does not allow public subsidy that takes away from global corporate profits. So, just think what this game is-----people once fully insured in good private corporate plans or public sector health plans that are being axed are now being moved onto Medicaid with this Federal funding for a few years and then VOILA----
ALL THAT FEDERAL FUNDING FOR MEDICAID ENDS BECAUSE OF THE ECONOMIC CRASH FROM THE COLLAPSING BOND MARKET.
So, Medicaid having already been slashed of funding back in 2010 will be slashed again as Medicaid no longer looks like Medicaid and while more and more Americans are being pushed to Medicaid.
THIS IS HOW YOU END A FEDERAL PUBLIC HEALTH PLAN THAT IS A CONSTITUTIONAL RIGHT----IT IS SO DEFUNDED AND OUTSOURCED AS TO HAVE NO ONE WANTING TO USE IT.
That is the goal-----and that is a Clinton neo-liberal for you!!!!
Keep in mind as you read this the level of health industry fraud over just a few decades against Medicaid ----trillions of dollars that should be coming back and all that fraud ignored because we have Clinton neo-liberals instead of Democrats in office.
As Number of Medicaid Patients Goes Up, Their Benefits Are About to Drop
By ROBERT PEARJUNE 15, 2011
WASHINGTON — The Obama administration injected billions of dollars into Medicaid, the nation’s low-income health program, as the recession deepened two years ago. The money runs out at the end of this month, and benefits are being cut for millions of people, even though unemployment has increased.
From New Jersey to California, state officials are bracing for the end to more than $90 billion in federal largess specifically designated for Medicaid. To hold down costs, states are cutting Medicaid payments to doctors and hospitals, limiting benefits for Medicaid recipients, reducing the scope of covered services, requiring beneficiaries to pay larger co-payments and expanding the use of managed care.
As a result, costs can be expected to rise in other parts of the health care system. Cuts in Medicaid payments to doctors, for example, make it less likely that they will accept Medicaid patients and more likely that people will turn to hospital emergency rooms for care. Hospitals and other health care providers often try to make up for the loss of Medicaid revenue by increasing charges to other patients, including those with private insurance, experts say.
Neither the White House nor Congress has tried to extend the extra federal financing for Medicaid, even though the number of beneficiaries is higher now than when Congress approved the aid as part of an economic recovery package in February 2009.
The Congressional Budget Office estimates that federal Medicaid spending will decline in 2012 for only the second time in the 46-year history of the program. But states say they will have to have to spend more on Medicaid as they struggle to make up for the loss of federal money.
State officials say they are resigned to the loss of the extra federal matching payments, given the climate in Congress, where deficit reduction is a paramount goal.
“We all see the reality of what’s going on in Congress,” said Mark W. Rupp, director of the Washington office of Gov. Christine Gregoire of Washington State, a Democrat who is chairwoman of the National Governors Association. “It’s more about cutting than spending. Why put a lot of effort into something that did not seem likely to have a positive outcome? It would have been fairly futile.”
Although Medicaid provides health insurance to one in five Americans at some point in a year, it is more vulnerable to cuts than Medicare and Social Security, which have broader political support.
“Medicaid is very much on the chopping block,” said Senator John D. Rockefeller IV, Democrat of West Virginia and chairman of the Senate Finance Subcommittee on Health Care. “Seniors vote. But if you are poor and disabled, you might not vote, and if you are a child, you do not vote — that’s a lot of Medicaid’s population. They don’t have money to do lobbying.”
Medicaid is financed jointly by the federal government and the states, with the federal government paying a larger share in poorer states like Mississippi and West Virginia and a smaller share in higher-income states like New York and Connecticut.
The aid ending next month increased the federal share of Medicaid spending in all states, with additional help for states where unemployment rates had risen sharply. The extra aid was scheduled to expire last December, but Congress extended it for six months at the urging of the White House and state officials.
The additional money pushed the average federal share of Medicaid spending nationwide to 67 percent. It will revert to 57 percent next month. The cutback in federal Medicaid money has put pressure on states to cut the budget for other programs, including education and social services.
Toby J. Douglas, director of the California Department of Health Care Services, said the federal Medicaid cut was causing “very consequential reductions in health care and other public programs.”
California is cutting Medicaid payments to doctors and many other providers by 10 percent; has established new co-payments for drugs, doctors’ services and hospital care; and will limit beneficiaries to seven doctor’s office visits a year unless a doctor certifies a need for more.
With 7.6 million Medicaid beneficiaries — 50 percent more than any other state — California faces bigger problems, but its response has been typical. A survey issued this month by the National Association of State Budget Officers found that 24 states were reducing Medicaid payments to providers, while 20 were limiting benefits in some way.
R. Andrew Allison, who is executive director of the Kansas Health Policy Authority and president of the National Association of Medicaid Directors, said Medicaid was gobbling up new revenues as states recovered slowly from the recession.
Kansas illustrates the predicament most states are facing. Federal Medicaid payments in Kansas are expected to decline by more than $250 million, or 13 percent, in the state’s new fiscal year, which starts July 1, Mr. Allison said. But the amount of state revenue spent on Medicaid is expected to increase by more than $300 million, or 39 percent.
New York has just imposed a cap on state Medicaid spending, with a separate limit for each sector like hospitals, nursing homes and managed care plans. Under a new state law, if it appears that the state share of Medicaid spending will exceed the cap, New York officials must devise and carry out a plan to reduce spending, by modifying benefits, provider payment rates or other features of the program.
“This is an enormous sea change for Medicaid,” said Jeffrey Gordon, a spokesman for the New York State Health Department.
Continue reading the main story Write A Comment In New Jersey, Gov. Chris Christie, a Republican, said, “Medicaid’s growth is out of control,” and he has proposed numerous changes “to fill in the hole created by the loss of over a billion dollars of federal stimulus money” for the program. He would tighten eligibility, reduce Medicaid payment rates for nursing homes, move older and disabled Medicaid recipients into managed care, and charge co-payments for medical day care services.
The New Jersey Legislature appears likely to accept some of the changes in a budget to be adopted this month.
Connecticut has avoided major cuts in Medicaid, but the State Legislature has set new limits on vision and dental coverage for adults.
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Below you see what will replace Medicare and Medicaid in Maryland and it is no coincidence that the head of this health exchange non-profit is a Johns Hopkins partner. As you see below they are moving Maryland's Veterans to this non-profit because the Veteran's Administration is being privatized and closed and Veteran's benefits are being defunded-----ergo all of the charity ads on TV.
The VA is a Federal health program that veterans paid for with service and as a Federal program will fall into these non-profit health insurance plans along with Medicaid and Medicare. Since Hopkins controls most of the health care in the Baltimore region it will use this format of non-profits to control all government funding to care for the poor, seniors, disabled, and veterans.
This non-profit format will replace all public health programs at the same time private insurance corporations go global and become so expensive that most Americans will not be able to afford them and be pushed into these non-profit plans. What will this ghettoized health insurance look like? As I said years ago-----it will be the same kind of preventative clinic care that people in third world nations receive..
THIS IS TO WHERE OVER 80% OF MARYLANDERS WILL GO UNDER MARYLAND'S PRIVATIZED SINGLE-PAYER-----
See why Expanded and Improved Medicare for All is better and we need to start building the platform in Baltimore right now----the 2016 election should have all Democratic primary candidates shouting how they are going to install Medicare for All. In Maryland, Clinton neo-liberals and Baltimore's neo-conservatives running as Democrats are still trying to pretend the Affordable Care Act was progressive.
Beilenson was at Hopkins as all of Baltimore's VA functions were dismantled and doctors with the VA courted to Hopkins health tourism.
Improving access for Veterans by giving them access to preventative care only!!!!! HOW SPECIAL!!!
Maryland Politics
Maryland veterans waiting for primary care have a new option: Evergreen Health Care
Peter Beilenson of Evergreen Health Care. (Ricky Carioti/The Washington Post) By Jenna Johnson September 1, 2014 Veterans who have been waiting for months to see a primary-care doctor through the Veterans Affairs Maryland Health Care System can visit one of the four Evergreen Health Care facilities that are affiliated with the state’s new health insurance co-op.
Maryland VA officials signed a contract with Evergreen in August to spend up to $485,000 for ongoing primary care for as many as 1,000 veterans. The contract could change based on need.
Adam M. Robinson Jr., VA Maryland Health Care System chief of staff, said in a statement Thursday that the “partnership is a major component of our aggressive action plan to improve patient access.”
#pmad-01-frame { display: inline-block; width: 300px; height: 90px; } VA medical systems are required to see new patients within 14 days after their paperwork is accepted and returning patients within 14 to 30 days of an appointment request. Some states have been accused of tampering with their scheduling to hide backlogs.
An audit of the Maryland VA system this year found no improper scheduling, according to the statement, but discovered that the system was not seeing new patients quickly enough.
Maryland veterans will have the choice of continuing to wait to see a primary-care doctor through VA or seeing a doctor at one of Evergreen’s health facilities in Baltimore, Columbia, White Marsh or Greenbelt.
“It’s totally up to the veteran,” said Peter Beilenson, chairman of the board of Evergreen Health Care and founder of its affiliated insurance company.
Veterans can return for up to six visits a year, Beilenson said, and will be referred back to VA for more serious problems that require a specialist. In addition to general primary care, Evergreen can provide screenings, wellness programs and counseling.
The partnership means a rush of new patients for the Evergreen clinics, where business has been much slower than expected because not enough people have signed up for health insurance through Evergreen Health Co-op, a start-up made possible by the Affordable Care Act.
About two dozen such nonprofit co-ops are operating across the country, with varying degrees of success. They aim to shake up the insurance market by offering low-priced, high-perks plans that can bring down health-care costs.
#pmad-02-frame { display: inline-block; width: 300px; height: 90px; } Unlike other co-ops, Evergreen has affiliated health-care centers for members that focus on preventive care and general wellness.
Evergreen planned to find its customers on Maryland’s online health-insurance marketplace, at which plans from four carriers would be clearly detailed. Beilenson thought Evergreen easily could enroll 10,000 people in the first year.
But the state Web site crashed the day it debuted last year, struggled through the six-month-long enrollment period and is being rebuilt before the next open-enrollment period starts Nov. 15.
Maryland enrolled 72,000 people in private plans, roughly half of the state’s original estimate. Of those, 94 percent chose a plan from CareFirst, a major Maryland-based insurance carrier that often had plans with the lowest premiums.
For the second open enrollment, CareFirst will increase its premiums by about 10 percent to 16 percent, while the other three carriers will decrease premiums. Evergreen’s rates will be about 10 percent lower.
“They grossly underpriced the market on purpose,” Beilenson said of CareFirst in its first year on the exchange. “We’re going to be much more competitive.”
Evergreen has found success in selling coverage to small groups and businesses, offering lower prices and promising to keep those prices for two years. The co-op has 3,600 members and hopes to have 6,000 by the end of the year, Beilenson said.
When reports of long waits for veterans surfaced this year, Beilenson reached out to Maryland officials and offered to treat their patients in his health centers. He said more than 700 veterans in Maryland have been waiting for at least 90 days for appointments.
Evergreen saw its first veteran Friday morning in Columbia, he said, and plans to see many more on Tuesday.
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