MOVING MOST PEOPLE TO MEDICAID-LEVEL ACCESS TO HEALTH CARE WHILE DEFUNDING AND DISMANTLING MEDICAID........WHY ARE YOU SHOUTING TO EXPAND MEDICAID WHEN WE NEED TO DEMAND EXPANDED AND IMPROVED MEDICARE FOR ALL?
As you see below Obama and neo-liberals are setting the stage for ending Medicare and Medicaid with private state systems that will be the recipient of all public health and corporate health plan populations---from entitlements to Veterans Admin to labor union benefits. The bundling of payments with gutted funding is starting the dismantling of standard levels of care for all in each of these programs moving to income level and the ability to buy private insurance. The next step will be-----Block Grants. As I said, Obama's HHS appointment is on record for thinking block grants are the most 'effective' dispensation of Federal funds for public health care. As we see as well, when funds are sent to the states ----equal protection, access, and accountability disappear. Maryland is one of the worst in Medicare and Medicaid fraud and corruption and health disparity because of the handling of Federal funds in this block grant fashion free from Federal Medicare oversight.
Two years ago, neo-liberal pundit EJ DIONNE of the Washington Post mocked the American people by saying that those wanting single-payer will be getting it. He means of course that over 80% of Americans will have been moved to a Medicaid or uninsured status in little over a decade if Affordable Care Act is allowed to continue. Think how much income a Veteran has.....most labor union employees now that their wages are being slashed.....how much income/wealth seniors have after the decade of massive corporate fraud hit retirement wealth. If we go to an income-based health insurance system which is what these tiered-health systems are.....over 80% will receive only preventative care and fall into these third world clinic-level of care. So, shouting out for Expanded Medicaid is a mockery of what most citizens in America have paid into this Medicare Trust and whose taxes paid over decades funding all of the health research and development that neo-liberals and neo-cons are trying to deny access to. Just because you are poor now as a result of a Bains Capital attack on the US economy-----doesn't mean you were not middle-class most of your life and deserve Medicare/VA benefits/Medicaid that provides basic medical access.
Do not fall for the bells and whistles of 'donut holes' and 'coverage for people with pre-conditions'.....children stay on their parents plan until 27......WHO WILL HAVE A PLAN? The goal of Affordable Care Act is maximizing profit and bells and whistles will not last long.
DEMAND EXPANDED AND IMPROVED MEDICARE FOR ALL. THIS WILL ASSURE NO MATTER THE LOSS OF LABOR BENEFITS, VA BENEFITS, OR REAL HEALTH COVERAGE WITH MEDICAID----THAT EVERYONE WILL RECEIVE THE LEVEL OF CARE THEY NEED AND DESERVE.
IT IS ALL PAID BY SIMPLY ENDING FRAUD, CORRUPTION, AND PROFITEERING IN THE HEALTH INDUSTRY....EASY PEASY.
Savings in Medicaid Series Increase Detection and Prevention of Fraud, Waste and Abuse
Issue Defined
Fraud, waste and abuse plague the healthcare industry and account for hundreds of billions of dollars lost annually, affecting taxpayers, the Medicare and Medicaid programs and all of their stakeholders. Although there is increased awareness, as well as action being taken, more can be done to detect and prevent fraud, waste and abuse.
Remember-----if you think it is fine for the poor to die without accessing basic medical procedures-----we have an economic crash coming soon that will send even more of what is left of the American middle-class into poverty so you, your children, or grandchildren may be those poor no longer accessing basic health care.
As you see, block granting has been sounded rejected by the American people and yet-----all of the movement in health reform by Obama and Congressional neo-liberals---and indeed, here in Maryland----is to block grants.
Medicaid Block Grants: A Zombie Idea With Lipstick in Texas
Posted: 04/09/2013 5:06 pm 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 Foundation.
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.
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As you see below the ACA has so many loopholes and special exceptions that the level of care always printed on the Medicaid page looks nothing like you think it should. Most low-wage workers will fall into the 'skinny' category that is preventative care only. This is what most Medicaid will look like. So, people are being categorized as having health insurance whether Medicaid or Bronze level plan----but they are not accessing health care. America has had since Reagan/Clinton the worst health care access in the developed world----the Affordable Care Act takes that lower.
Remember, the Affordable means the cheapest care for the most profit.
Why Health Law's 'Essential' Coverage Might Mean 'Bare Bones'
By Jay Hancock
KHN Staff Writer
Aug 25, 2013
It came as a surprise to some that the Affordable Care Act seems to allow large employers to offer health insurance that pays for preventive care and not much else. Check out our story on "skinny" plans quoting a consultant saying that for employers with 50 or more workers, “the feds imposed no minimum standard on how skimpy that coverage can be other than to say, in essence, it’s got to be more robust than a dental plan or a vision plan." (The Wall Street Journal broke the story here in May. Subscription required.)
Retailers, restaurant chains and temporary staffing companies are said to be interested.
But how can a law praised for expanding coverage -- one that includes an "employer mandate" to offer "minimum essential coverage" -- allow companies to offer insurance that might not even cover hospitalization?
Take a walk through the ACA weeds to see why.
First of all, there is no outright ban on skinny plans -- even after the employer mandate kicks in in 2015. Instead, large employers -- those with 50 or more full-time employees -- run the risk of fines only if the coverage doesn't conform to ACA rules. The regulations published so far, however, seem to allow skinny plans with a penalty that many employers may choose to pay because it is less costly than offering fuller coverage.
There are two fines in the health law for large employers failing to offer adequate coverage. First, any company that does not offer "minimum essential coverage" is liable for a $2,000-per-worker penalty (minus the first 30 workers), triggered when at least one employee enrolls in subsidized coverage in the online marketplaces known as exchanges.
But what is minimum essential coverage? Not as robust as you might think. To start, don't confuse it with "essential health benefits," including maternity benefits and prescription drugs, that must be included in plans sold to individuals or small employers.
If health insurance is merely sponsored by an employer, it passes one test for minimum essential coverage.
Story Components
Neither the law, nor the regulations say much about what minimum essential coverage offered by a large employer is. As a result, many experts believe large employers can shield themselves from the $2,000 penalty by offering a plan that covers the health law's required preventive care, but still leaves workers vulnerable to thousands in bills if they're hospitalized. If employees sign up for such plans, which may cost as little as $50 a month, they would also be protected from health-law penalties levied on individuals without coverage.
The health law also fines employers that don't offer "minimum value" in their health plans, says Alden Bianchi, a Boston-based benefits and compensation lawyer. Skinny coverage flunks that test, based on regulations that measure minimum value against "benchmark plans" in each state, Bianchi said. But the employer penalty is only $3,000 for each worker enrolling in subsidized exchange coverage. That's likely to be much less than the fine for not offering minimum essential coverage, which is $2,000 for nearly every employee in the company, even if most don't buy policies in the exchanges.
But what about other rules governing health benefits? What about the part of the health law that bans insurers from cutting off benefits at a certain dollar level? Not a problem for skinny plans. Unlike the "mini-med" plans in common use before the law was passed, they don't impose a dollar cap; they merely exclude large categories of care, which also keeps down costs.
What about new rules limiting out-of-pocket expenses for consumers? For 2014, your plan can't make you pay more in co-pays and deductibles than $6,350 for individuals and $12,700 for families. (That may temporarily be higher if your employer has separate administrators for drug benefits and doctors and hospitals.) Skinny plans pass the test again. Out-of-pocket caps are for covered care only, and skinny plans don't cover much care.
What about restrictions on self-insured employers (the large majority of large companies are self-insured) offering a rich-benefit plan to managers and a limited-benefit plan to hourly workers? Skinny plans survive this one, too, says Ed Fensholt, a senior vice president at Lockton Cos., a large insurance broker. These non-discrimination rules contain exceptions for high-turnover workers, he said. And they require employers only to offer the management plan to hourly workers, not for the workers to enroll.
"That plan would be priced at a place where relatively few rank and file employees would want it," Fensholt says. "And then they'd offer the skinny plan to the rank and file."
When asked about the situation, the Obama administration said consumers lacking good coverage "can enter into the marketplaces and choose a health insurance option that works for them."
Bianchi, who represents large employers, says the people who wrote the law intended to give companies a bare-bones option.
"The ability to offer such plans is a result of conscious policy decisions by Congress, as implemented by the regulators," he wrote in an industry brief.
The Cato Institute's Michael Cannon, on the other hand, suspects the administration "had no idea what they were doing," as he wrote on the libertarian think tank's blog.
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Raising the level of Medicaid eligibility when Medicaid is simply a preventative checkup/clinic care is not a boon for most US citizens who used to have labor union contracts and benefits. I have shown that all those health plans lost in corporate bankruptcies are now sitting in a Federal agency and the people once having strong health benefits are getting little over Medicaid-level care. One the the deals made in these bankruptcy agreements was that corporations would pay into this Federal agency program -----but they are not so the funding is not there and hundreds of billions of dollars in unfunded need is there. Neo-liberals and neo-cons have no intention of using the oversight and accountability needed to get that money -----and the pension fraud that hit this agency and all pensions----ALL OF WHICH WOULD LEAVE MANY AMERICAN PEOPLE WITH DECENT HEALTH COVERAGE. ALL WILL BE LEFT TO MEDICAID-LEVEL CARE.
Most doctors will not be seeing Medicaid patients and in fact it is nurse practitioners who are being sent to clinics to replace the doctor. I am definitely for nurse practitioners----but they cannot provide any medical service other than preventative care.
Remember, everyone used to be able to go to the hospital and receive treatment for any ailment----so the poor had access to most care needed. So to pretend this Medicaid expansion is about giving the poor more care----IS A LIE....IT IS DENYING THEM BASIC MEDICAL CARE.
THE INSURANCE MANDATE WAS NEVER ABOUT FUNDING THIS EXPANDED CARE----IT WAS SIMPLY MEANT TO END PUBLIC HEALTH AND EXPAND PROFITS.
Attention Medicaid Patients: The Doctor Won't Be Seeing You
With its expansion of Medicaid eligibility, the Affordable Care Act (a.k.a. Obamacare) was supposed to go a long way towards providing healthcare coverage to millions of uninsured Americans. That accomplishment was dealt a large blow by the Supreme Court, when it forbade the federal government from requiring states to expand Medicaid coverage. Nevertheless, many states plan to offer Medicaid to anyone with incomes at or below 138% of the Federal Poverty Limit (FPL). And more states might follow suit over time, under pressure from the healthcare industry, which likes its customers to be paying customers.
However, even if Medicaid coverage expands under Obamacare, a big potential problem remains—many physicians will be unwilling to care for Medicaid patients. But how many physicians and which ones?
A July study in Health Affairs estimated the percent of physicians from a wide range of specialties who were unwilling to take on new Medicaid patients in 2011 and 2012. What specialty would you guess was least likely to accept new Medicaid patients?
If you are like me, you guessed some high-paying procedural subspecialty, like orthopedic surgery or ophthalmology, where the physicians are accustomed to high fees and well-paying patients. In the case of orthopedic surgery, you would not have been too far off—40% of these physicians were unwilling to make new patient visits available to Medicaid recipients. On the other hand, only 18% of ophthalmologists were unwilling to see Medicaid patients.
The “winner” was a surprise to me however: it was psychiatrists. A full 56% of them were not open to seeing new Medicaid patients. I don’t know why this is such a high number. Perhaps Medicaid enrollees have a higher than average rate of mental illness, and thus account for a disproportionate number of psychiatric patients, maxing out their ability to care for those patients. Or perhaps Medicaid fees are particularly low for psychiatric care, relative to other forms of care. I’d be curious to see if any of you readers have any other ideas.
Which doctors do you think were most likely to accept new Medicaid enrollees? Once again, I was surprised by the answer: it was cardiologists. Only 9% were unwilling to take on new Medicaid patients.
I am not knowledgeable enough about Medicaid to understand what is going on here. I would love to hear ideas from all of you.
But meanwhile, I leave you with a simple take home point: healthcare coverage does not equate with access to healthcare. Physicians have to be willing to see patients. And if Medicaid does not pay well enough to incentivize physicians to see Medicaid patients, or if it is too slow to pay off claims, or if some other barrier stands in the way of helping these patients receive needed medical care—then we need to address those barriers. It is no use to obtain healthcare coverage that doesn’t get you healthcare!
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This poll shows Medicaid numbers before ACA----the numbers will soar as corporations drop plans and the working and middle-class become unable to meet insurance co-pays and deductibles. Do you know the growing population of people on Medicaid? College graduates left unemployed by global corporations deliberately stagnating the economy.
As you see below Obama and neo-liberals are setting the stage for ending Medicare and Medicaid with private state systems that will be the recipient of all public health and corporate health plan populations---from entitlements to Veterans Admin to labor union benefits. The bundling of payments with gutted funding is starting the dismantling of standard levels of care for all in each of these programs moving to income level and the ability to buy private insurance. The next step will be-----Block Grants. As I said, Obama's HHS appointment is on record for thinking block grants are the most 'effective' dispensation of Federal funds for public health care. As we see as well, when funds are sent to the states ----equal protection, access, and accountability disappear. Maryland is one of the worst in Medicare and Medicaid fraud and corruption and health disparity because of the handling of Federal funds in this block grant fashion free from Federal Medicare oversight.
Two years ago, neo-liberal pundit EJ DIONNE of the Washington Post mocked the American people by saying that those wanting single-payer will be getting it. He means of course that over 80% of Americans will have been moved to a Medicaid or uninsured status in little over a decade if Affordable Care Act is allowed to continue. Think how much income a Veteran has.....most labor union employees now that their wages are being slashed.....how much income/wealth seniors have after the decade of massive corporate fraud hit retirement wealth. If we go to an income-based health insurance system which is what these tiered-health systems are.....over 80% will receive only preventative care and fall into these third world clinic-level of care. So, shouting out for Expanded Medicaid is a mockery of what most citizens in America have paid into this Medicare Trust and whose taxes paid over decades funding all of the health research and development that neo-liberals and neo-cons are trying to deny access to. Just because you are poor now as a result of a Bains Capital attack on the US economy-----doesn't mean you were not middle-class most of your life and deserve Medicare/VA benefits/Medicaid that provides basic medical access.
Do not fall for the bells and whistles of 'donut holes' and 'coverage for people with pre-conditions'.....children stay on their parents plan until 27......WHO WILL HAVE A PLAN? The goal of Affordable Care Act is maximizing profit and bells and whistles will not last long.
DEMAND EXPANDED AND IMPROVED MEDICARE FOR ALL. THIS WILL ASSURE NO MATTER THE LOSS OF LABOR BENEFITS, VA BENEFITS, OR REAL HEALTH COVERAGE WITH MEDICAID----THAT EVERYONE WILL RECEIVE THE LEVEL OF CARE THEY NEED AND DESERVE.
IT IS ALL PAID BY SIMPLY ENDING FRAUD, CORRUPTION, AND PROFITEERING IN THE HEALTH INDUSTRY....EASY PEASY.
Savings in Medicaid Series Increase Detection and Prevention of Fraud, Waste and Abuse
Issue Defined
Fraud, waste and abuse plague the healthcare industry and account for hundreds of billions of dollars lost annually, affecting taxpayers, the Medicare and Medicaid programs and all of their stakeholders. Although there is increased awareness, as well as action being taken, more can be done to detect and prevent fraud, waste and abuse.
Remember-----if you think it is fine for the poor to die without accessing basic medical procedures-----we have an economic crash coming soon that will send even more of what is left of the American middle-class into poverty so you, your children, or grandchildren may be those poor no longer accessing basic health care.
As you see, block granting has been sounded rejected by the American people and yet-----all of the movement in health reform by Obama and Congressional neo-liberals---and indeed, here in Maryland----is to block grants.
Medicaid Block Grants: A Zombie Idea With Lipstick in Texas
Posted: 04/09/2013 5:06 pm 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 Foundation.
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.
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As you see below the ACA has so many loopholes and special exceptions that the level of care always printed on the Medicaid page looks nothing like you think it should. Most low-wage workers will fall into the 'skinny' category that is preventative care only. This is what most Medicaid will look like. So, people are being categorized as having health insurance whether Medicaid or Bronze level plan----but they are not accessing health care. America has had since Reagan/Clinton the worst health care access in the developed world----the Affordable Care Act takes that lower.
Remember, the Affordable means the cheapest care for the most profit.
Why Health Law's 'Essential' Coverage Might Mean 'Bare Bones'
By Jay Hancock
KHN Staff Writer
Aug 25, 2013
It came as a surprise to some that the Affordable Care Act seems to allow large employers to offer health insurance that pays for preventive care and not much else. Check out our story on "skinny" plans quoting a consultant saying that for employers with 50 or more workers, “the feds imposed no minimum standard on how skimpy that coverage can be other than to say, in essence, it’s got to be more robust than a dental plan or a vision plan." (The Wall Street Journal broke the story here in May. Subscription required.)
Retailers, restaurant chains and temporary staffing companies are said to be interested.
But how can a law praised for expanding coverage -- one that includes an "employer mandate" to offer "minimum essential coverage" -- allow companies to offer insurance that might not even cover hospitalization?
Take a walk through the ACA weeds to see why.
First of all, there is no outright ban on skinny plans -- even after the employer mandate kicks in in 2015. Instead, large employers -- those with 50 or more full-time employees -- run the risk of fines only if the coverage doesn't conform to ACA rules. The regulations published so far, however, seem to allow skinny plans with a penalty that many employers may choose to pay because it is less costly than offering fuller coverage.
There are two fines in the health law for large employers failing to offer adequate coverage. First, any company that does not offer "minimum essential coverage" is liable for a $2,000-per-worker penalty (minus the first 30 workers), triggered when at least one employee enrolls in subsidized coverage in the online marketplaces known as exchanges.
But what is minimum essential coverage? Not as robust as you might think. To start, don't confuse it with "essential health benefits," including maternity benefits and prescription drugs, that must be included in plans sold to individuals or small employers.
If health insurance is merely sponsored by an employer, it passes one test for minimum essential coverage.
Story Components
- Bare Bones Health Plans Expected To Survive Health Law
- Why Health Law's 'Essential' Coverage Might Mean 'Bare Bones'
Neither the law, nor the regulations say much about what minimum essential coverage offered by a large employer is. As a result, many experts believe large employers can shield themselves from the $2,000 penalty by offering a plan that covers the health law's required preventive care, but still leaves workers vulnerable to thousands in bills if they're hospitalized. If employees sign up for such plans, which may cost as little as $50 a month, they would also be protected from health-law penalties levied on individuals without coverage.
The health law also fines employers that don't offer "minimum value" in their health plans, says Alden Bianchi, a Boston-based benefits and compensation lawyer. Skinny coverage flunks that test, based on regulations that measure minimum value against "benchmark plans" in each state, Bianchi said. But the employer penalty is only $3,000 for each worker enrolling in subsidized exchange coverage. That's likely to be much less than the fine for not offering minimum essential coverage, which is $2,000 for nearly every employee in the company, even if most don't buy policies in the exchanges.
But what about other rules governing health benefits? What about the part of the health law that bans insurers from cutting off benefits at a certain dollar level? Not a problem for skinny plans. Unlike the "mini-med" plans in common use before the law was passed, they don't impose a dollar cap; they merely exclude large categories of care, which also keeps down costs.
What about new rules limiting out-of-pocket expenses for consumers? For 2014, your plan can't make you pay more in co-pays and deductibles than $6,350 for individuals and $12,700 for families. (That may temporarily be higher if your employer has separate administrators for drug benefits and doctors and hospitals.) Skinny plans pass the test again. Out-of-pocket caps are for covered care only, and skinny plans don't cover much care.
What about restrictions on self-insured employers (the large majority of large companies are self-insured) offering a rich-benefit plan to managers and a limited-benefit plan to hourly workers? Skinny plans survive this one, too, says Ed Fensholt, a senior vice president at Lockton Cos., a large insurance broker. These non-discrimination rules contain exceptions for high-turnover workers, he said. And they require employers only to offer the management plan to hourly workers, not for the workers to enroll.
"That plan would be priced at a place where relatively few rank and file employees would want it," Fensholt says. "And then they'd offer the skinny plan to the rank and file."
When asked about the situation, the Obama administration said consumers lacking good coverage "can enter into the marketplaces and choose a health insurance option that works for them."
Bianchi, who represents large employers, says the people who wrote the law intended to give companies a bare-bones option.
"The ability to offer such plans is a result of conscious policy decisions by Congress, as implemented by the regulators," he wrote in an industry brief.
The Cato Institute's Michael Cannon, on the other hand, suspects the administration "had no idea what they were doing," as he wrote on the libertarian think tank's blog.
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Raising the level of Medicaid eligibility when Medicaid is simply a preventative checkup/clinic care is not a boon for most US citizens who used to have labor union contracts and benefits. I have shown that all those health plans lost in corporate bankruptcies are now sitting in a Federal agency and the people once having strong health benefits are getting little over Medicaid-level care. One the the deals made in these bankruptcy agreements was that corporations would pay into this Federal agency program -----but they are not so the funding is not there and hundreds of billions of dollars in unfunded need is there. Neo-liberals and neo-cons have no intention of using the oversight and accountability needed to get that money -----and the pension fraud that hit this agency and all pensions----ALL OF WHICH WOULD LEAVE MANY AMERICAN PEOPLE WITH DECENT HEALTH COVERAGE. ALL WILL BE LEFT TO MEDICAID-LEVEL CARE.
Most doctors will not be seeing Medicaid patients and in fact it is nurse practitioners who are being sent to clinics to replace the doctor. I am definitely for nurse practitioners----but they cannot provide any medical service other than preventative care.
Remember, everyone used to be able to go to the hospital and receive treatment for any ailment----so the poor had access to most care needed. So to pretend this Medicaid expansion is about giving the poor more care----IS A LIE....IT IS DENYING THEM BASIC MEDICAL CARE.
THE INSURANCE MANDATE WAS NEVER ABOUT FUNDING THIS EXPANDED CARE----IT WAS SIMPLY MEANT TO END PUBLIC HEALTH AND EXPAND PROFITS.
Attention Medicaid Patients: The Doctor Won't Be Seeing You
With its expansion of Medicaid eligibility, the Affordable Care Act (a.k.a. Obamacare) was supposed to go a long way towards providing healthcare coverage to millions of uninsured Americans. That accomplishment was dealt a large blow by the Supreme Court, when it forbade the federal government from requiring states to expand Medicaid coverage. Nevertheless, many states plan to offer Medicaid to anyone with incomes at or below 138% of the Federal Poverty Limit (FPL). And more states might follow suit over time, under pressure from the healthcare industry, which likes its customers to be paying customers.
However, even if Medicaid coverage expands under Obamacare, a big potential problem remains—many physicians will be unwilling to care for Medicaid patients. But how many physicians and which ones?
A July study in Health Affairs estimated the percent of physicians from a wide range of specialties who were unwilling to take on new Medicaid patients in 2011 and 2012. What specialty would you guess was least likely to accept new Medicaid patients?
If you are like me, you guessed some high-paying procedural subspecialty, like orthopedic surgery or ophthalmology, where the physicians are accustomed to high fees and well-paying patients. In the case of orthopedic surgery, you would not have been too far off—40% of these physicians were unwilling to make new patient visits available to Medicaid recipients. On the other hand, only 18% of ophthalmologists were unwilling to see Medicaid patients.
The “winner” was a surprise to me however: it was psychiatrists. A full 56% of them were not open to seeing new Medicaid patients. I don’t know why this is such a high number. Perhaps Medicaid enrollees have a higher than average rate of mental illness, and thus account for a disproportionate number of psychiatric patients, maxing out their ability to care for those patients. Or perhaps Medicaid fees are particularly low for psychiatric care, relative to other forms of care. I’d be curious to see if any of you readers have any other ideas.
Which doctors do you think were most likely to accept new Medicaid enrollees? Once again, I was surprised by the answer: it was cardiologists. Only 9% were unwilling to take on new Medicaid patients.
I am not knowledgeable enough about Medicaid to understand what is going on here. I would love to hear ideas from all of you.
But meanwhile, I leave you with a simple take home point: healthcare coverage does not equate with access to healthcare. Physicians have to be willing to see patients. And if Medicaid does not pay well enough to incentivize physicians to see Medicaid patients, or if it is too slow to pay off claims, or if some other barrier stands in the way of helping these patients receive needed medical care—then we need to address those barriers. It is no use to obtain healthcare coverage that doesn’t get you healthcare!
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This poll shows Medicaid numbers before ACA----the numbers will soar as corporations drop plans and the working and middle-class become unable to meet insurance co-pays and deductibles. Do you know the growing population of people on Medicaid? College graduates left unemployed by global corporations deliberately stagnating the economy.
- May 25, 2011, 9:48 AM ET
- By Katherine Hobson
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