OBAMA IS TEEING THE HEALTH CARE PRIVATIZATION UP FOR CLINTON TO COME ON BOARD AND PASS YET ANOTHER REPUBLICAN POLICY-----ENDING MEDICARE AND MEDICAID BY SENDING THEM TO STATES AS BLOCK GRANTS AND CAPS ON BENEFITS. THAT IS WHAT THESE STATE HEALTH SYSTEMS ARE PREPARING TO DO!
WHO SUPPORTS NEO-LIBERALS EVERY ELECTION? LABOR AND JUSTICE ORGANIZATIONS. DO THESE ORGANIZATIONS REALLY WANT TO END ALL OF OUR SAFETY NETS WHEN THEY SUPPORT NEO-LIBERALS?
PLEASE GLANCE THROUGH TO LAST ARTICLE!
Below you see a good summation of the debate over ending Medicaid by sending it to the states as block grants and in some cases a caps policy. You see that Bill and Hillary Clinton are all for deregulating and sending to the states Medicaid but as we heard from Burwell in her confirmation hearing she will do the same for Medicare. THIS IS HOW YOU END THESE FEDERAL PROGRAMS. Now, I've talked about how Medicare Advantage exists to privatize Medicare as well, but cutting almost $1 trillion dollars to force lower payments to doctors is the best plan for ending Medicare as doctors simply will not take patients. That is what block grants end up doing as well.....states slowly defund Medicaid or install hard to meet rules-----like Texas has done to abortion clinics to close them. This is what deregulation of health care looks like.....it will be a mess and the American people will not be able to trust that the quality of care or the person giving them care is reputable. Remember, Medicaid and Medicare cover the poor and seniors and with poverty levels in the US right now at 70%-----these policies will affect almost all people.
WE ALL KNOW THE PROBLEM WITH COST FOR MEDICARE AND MEDICAID IS SYSTEMIC FRAUD AND CORRUPTION. IT TAKES $400 BILLION AND MORE EACH YEAR----ALMOST 1/2 OF EXPENDITURES. SENDING IT TO THE STATES MAKES THAT SOAR.
What neo-liberals Clinton/Obama along with Republicans always say----send it to the states to be run more efficiently-----well, the fraud and corruption comes from the failure of states like Maryland to provide oversight and accountability. What Clinton and Republicans want to do is use block grants and caps to deregulate what quality health care looks like and caps will end the idea of Hippocratic Oath because doctors will no longer do what is required for a person's health but rather what can be done most cheaply.
It is interesting where we see in an article Obama once again saying one thing and doing another-----neo-liberals could care less what they say as they move forward an agenda of dismantling all of the public sector, public rights, and public justice. Obama says NO TO BLOCK GRANTS and uses it against Romney even as he brings Burwell to the Health and Human Services to do just that.
I'll start with the most vulnerable group -----the disabled-----but remember-----your family is most likely to fall into these problems as well. IT IS A SWEEPING ATTEMPT TO END ALL PUBLIC HEALTH.
REMEMBER, TRANS PACIFIC TRADE PACT AND CLINTON AND OBAMA ARE PUSHING AS HARD AS THEY CAN TO DO THIS AROUND THE WORLD----THEY WILL DO IT HERE.
Medicaid Block Grant Information
How will Medicaid Block Grants Impact People with Intellectual and Developmental Disabilities and their Families?
Introduction
The House Budget Resolution for FY 2013 calls for drastic cuts to Medicaid ($810 billion over 10 years) that would fundamentally reshape the program—making it less reliable for the people who depend on it and shifting costs to consumers and to the states.
For millions of people living in poverty, Medicaid is a safety net. For many of the 7 million people with intellectual and developmental disabilities (I/DD), Medicaid is a life line. People with I/DD typically require more complex and costly services than Medicaid recipients without disabilities. Frequently, they need care from several different types of health care providers and they often need the services throughout their lifetimes.
What is a Medicaid “block grant?”
A Medicaid block grant would be a fixed amount of money from the federal government to the states to spend on health care for people who are poor, elderly, or have disabilities with only general rules and very little oversight about the way it is spent.
Based on previous federal block grants and the general statements that House Budget Committee Chairman Paul Ryan has made about the FY 2013 House Budget Resolution, we expect that a Medicaid block grant would:
All health care spending is growing. Experts claim that it will continue to grow and become an ever larger share of our federal budget. Most Members of Congress are looking for ways to get our fiscal house in order. Some Members of Congress are focusing on the growth of federal spending in the Medicaid program. They believe that block granting Medicaid will save federal dollars. Under a block grant, federal funding for Medicaid would not grow when more people need health services. The challenge of providing health care without any additional federal money to people who are poor, elderly or have disabilities would fall to the states.
What are the most critical Medicaid services for people with I/DD and how does Medicaid pay for them?
The most critical Medicaid services for people with I/DD are:
Is Medicaid an entitlement program?
Yes. This means that if a person meets the eligibility requirements (generally poverty, age and/or disability), he or she is entitled to the services available under the state Medicaid program.
What are people with disabilities currently entitled to in the Medicaid program?
Today, each state’s Medicaid program is required by the federal government to provide a minimum level of coverage for the elderly, people with disabilities, and low-income adults and children in order to receive federal matching payments. Minimum services include seeing a doctor, getting x-rays, going to the hospital, receiving care in a nursing home and vaccines for children. Nursing home care is also an entitlement and Medicaid pays for almost half of the long-term care expenditures in this country. It is the primary payer of long-term services and supports for people with I/DD.
What might states do if Medicaid is block granted?
Block grants could force bad choices and cause substantial conflict as groups with diverse needs compete for scarce dollars. Since the services to people with disabilities and the elderly are significantly more costly than health care coverage for children, states could decide to serve fewer costly adults and people with disabilities and focus scarce health care dollars on less costly children. However there is no certain way to know what states will do. Below are possible choices states might make:
No. Most people with I/DD cannot get medical insurance through an employer because they do not work full time. In fact only 21% of people with all disabilities are working (March 2011). Others cannot find health insurers who will sell them policies because of their pre-existing conditions. Many people with I/DD cannot afford health insurance. Some people with I/DD find that if insurers will sell them policies it does not cover the services they need or the coverage is exorbitantly expensive.
Why are we concerned that services to people with disabilities might be targeted in the states if Medicaid is turned into a block grant?
People with disabilities and the elderly account for most of the Medicaid spending. While children and parents make up about 75 percent of Medicaid enrollees, they account for less than a third of the spending. In contrast, the elderly and individuals with disabilities make up about 25 percent of enrollees but about two-thirds of spending. Medicaid spending per capita in 2009 was $3,442 for families (parents and children) and more than five times higher for the elderly and people with disabilities at $17,763. The elderly and people with disabilities use health care services more often and use more health services and the elderly and people with disabilities are more likely to use long-term services and supports. We are very concerned that states may slash the supports that help people with I/DD live independent, productive lives.
Are block grants cost effective?
A Medicaid block grant doesn’t control the cost of health care which continues to rise as people get older and use more health care services and as the general cost of all health care increases. They do shift more of the cost to that state and likely the individual. Costs may actually rise significantly because people who lose their health care or can’t afford it will stop seeing their doctors or taking their medication. When that happens it makes existing health conditions worse leading to more doctor or hospital visits and more costs down the road and the individual faces more illness and hardship. If home and community based services are reduced it will likely lead to greater levels of costly and unnecessary institutionalization or homelessness. If people are not provided needed services they may not be able to work, learn or function in the community. This creates lost productivity from the individual and family members if they are called upon to provide care when there are no other options.
What can advocates do?
Advocates must make clear to their Members of Congress that block granting Medicaid is not the answer to our nation’s deficit. Advocates must tell their Members what exactly is at stake. The health of people with I/DD may very well be at stake if it becomes more difficult or costly to access needed health services. What will happen if you or your family member loses services under Medicaid or if you have to pay for long term services and supports? Advocates must let their Members know what the biggest concerns are for individuals and families with I/DD if state Medicaid programs are turned into block grants. With less money, would states make it more difficult to become eligible for Medicaid?
Please take note at the information below because an article that follows with a pro-block granting view uses this Rhode Island model as proof it works well. As with all individual models-----they fund it well and run it looking nothing like it will look when installed.
[1] Center on Budget and Policy Priorities Rhode Island’s Global Waiver not a Model for How States Would fare under a Medicaid Block Grant, March 2011. Rhode Island’s block grant is held up as a model by some supporters of block grants. However, the state’s fixed amount of federal funds was greater than their normal federal share of Medicaid dollars. Rhode Island’s program does not reflect what likely would happen under block grant proposals currently being discussed. There also is disagreement about the state’s claims of savings under its block grant.
The article below is written by Wall Street so it is slanted to make these ideas look good. I think most people can see through deregulated health care and price caps on health coverage that will have 80% of people attached.
As you see this isn't a Romney and Republican vs the Democrats in Congress thing-----Bill and Hillary Clinton intend to do the same thing Romney is proposing and Obama's new Health and Human Services is tied to both!
Pharma & Healthcare 9/30/2012 @ 11:48PM
Why Block-Granting Medicaid Will Result in Better Health Care for the Poor
Avik Roy , Forbes Staff
In 1997, President Bill Clinton proposed a form of block grants for reforming the Medicaid program that Republicans might learn from.
Mitt Romney and Paul Ryan have proposed an important reform of the Medicaid program: giving federal Medicaid funds directly to states in the form of block grants, and giving the states broad autonomy in how they run those programs. It’s the formula that a Republican Congress and a Democratic President used in 1996 in the landmark welfare reform law of that year. But just as they were then, liberals today are up in arms about block grants, arguing that they will harm the poor. A new paper by my Manhattan Institute colleague Paul Howard proves the opposite: block grants will drive dramatic improvements in Medicaid’s ability to provide quality health care to the poor.
(DISCLOSURE: I am an outside adviser to the Romney campaign on health care issues. The opinions contained herein are mine alone, and do not necessarily correspond to those of the campaign.)
I’ve written often of the very serious problems with the Medicaid program. People on Medicaid have far worse health outcomes than those with private insurance, and in many cases those with no insurance at all. The main cause of Medicaid’s poor outcomes is that it’s very difficult for Medicaid patients to get doctors’ appointments, even for urgent medical problems. This poor access to care, in turn, is caused by the fact that Medicaid severely underpays doctors to care for Medicaid patients. In New York, for example, Medicaid pays 29 percent of what private insurers pay.
There are, in essence, two approaches to making Medicaid better. One would be to leave the program as is, unreformed, but throw more money at it, in order to pay doctors more. The other would be to reform the program, so as to make sure Medicaid dollars are directed toward actual health care, instead of waste, fraud, and abuse.
Doing nothing will worsen Medicaid patients’ access to care
IF YOU THINK THEY INTENDED TO STAY PAT WHEN THEY WROTE THE AFFORDABLE CARE ACT I HAVE SWAMP LAND IN FLORIDA TO SELL YOU!
There’s a third approach, the approach taken by Obamacare: shove 12 to 18 million more people into the existing Medicaid program, with all of its well-known problems, and otherwise standing pat. But that means consigning the poor to even worse health care in coming years.
In July, the State Budget Crisis Task Force—led by Paul Volcker and Richard Ravitch—released an important study, showing how inexorable growth in Medicaid spending is driving states bankrupt, and preventing them from funding other commitments, especially K-12 education. Because of all the constraints and red tape that the federal government places on the Medicaid program, states have one primary option for reducing their Medicaid spending: cutting provider reimbursements even further
States are very restricted in what else they can do. The 1965 Medicaid law severely restricts the ability of states to reform their Medicaid programs in other ways, such as modifying enrollment criteria, or changing the structure of the Medicaid insurance benefit. So they do the one thing they can: pay doctors less.
THIS IS EXACTLY WHAT AFFORDABLE CARE ACT DOES TO BOTH MEDICAID AND MEDICARE FOR THE EXACT REASONS.....MAKE IT HARDER TO FIND DOCTORS.
An annual 50-state survey conducted by the Kaiser Family Foundation, published last October, put it this way: “As in previous years, provider rate restrictions were the commonly reported cost containment strategy…A total of 39 states restricted provider rates in FY 2011 and 46 states reported plans to do so in FY 2012.” In other words, things are going to get worse for Medicaid patients, leading to even worse health outcomes.
Block grants will allow states to dramatically improve Medicaid’s efficiency
Imagine two people, Jack and Jill. I give Jack 100 dollars to buy food, and let him buy that food from wherever he wants. I give Jill the same $100, but only on the condition that Jill buy her food from Zagat-rated sushi restaurants in New York City. I’ve given Jack and Jill an equal amount of money. But Jack will be able to buy a lot more food with the money I’ve given him.
This is precisely the principle that block grants provide to Medicaid. Currently, the federal Medicaid law does the equivalent of giving the $100 to Jill and micromanaging her food consumption. We gave that same $100 to Jack, but he could buy a lot more food with the same money. Indeed, we could give Jack $90, and he would still be able to buy more food than Jill with her salmon sashimi.
Critics of block grants presume, for reasons that aren’t clear, that $100 spent in the current Medicaid program is equivalent to $100 spent by states in a more decentralized way. But as the story of Jack and Jill shows, there are, in theory, substantial efficiencies that can be gained by giving states broad flexibility in the way they care for the poor. Indeed, this is what made block-granting welfare in 1996 such a spectacular success.
As Paul points out in his excellent paper, block grants have been around for a long time. A government commission recommended them as early as 1949. In 1981, “Congress consolidated 50 federal aid programs into nine consolidated block grants” under the Omnibus Budget Reconciliation Act of that year. People in both parties have supported them as a way to put more money under the Jack model than the Jill one.
Three states are showing how block grants could improve Medicaid
Paul reviews how three states—Rhode Island, Indiana, and New York—have taken advantage of more flexibility to save money while delivering better care. (I’ve written previously about the Rhode Island and Indiana experiences.)
At the tail end of the George W. Bush administration, Rhode Island was granted a waiver by the federal government that, in effect, was a block grant: the state was assigned a five-year cap on Medicaid spending of $12.075 billion, in exchange for substantial flexibility to make changes to the program.
The program was a smashing success. Rhode Island was able to save $100 million, and slow the growth of Medicaid from 8 percent per year to 3 percent, by making a few tweaks to their program that they couldn’t before: shifting more Medicaid patients from nursing homes to home- and community-based services; automatically enrolling children with special needs and adults with disabilities into care-management programs; etc.
The best part is that, under a block-grant system, states can identify ways to save money while improving care, and other states can adopt best practices. Indiana, for example, took advantage of a waiver to introduce subsidized health-savings accounts into its Medicaid program, a reform that has been very popular with Medicaid enrollees—one survey showed a 94 percent satisfaction rate—and given Medicaid patients more control over their own health dollars. In theory, HSAs could allow Medicaid enrollees to pay market rates for needed care, improving access and health outcomes.
Bill Clinton’s idea for refining block grants with per-capita caps
Given our trillion-dollar deficits and Obamacare’s huge new spending commitments, we don’t have extra money available to put into the Medicaid program. That’s why Obamacare expanded Medicaid instead of putting all of those newly-subsidized patients onto the law’s more costly insurance exchanges.
There are ways to refine the block grant idea. One idea that Bill Clinton came up in the late 1990s was subjecting Medicaid block grants to a per-capita cap. Think of it as a block grant devolved to the individual, rather than the state, level. Under Clinton’s concept, federal Medicaid spending would be given to states based on the number of Medicaid enrollees in those states, and per-capita Medicaid spending would grow at an indexed rate (GDP plus one percent in his proposal).
Rep. Bill Cassidy (R., La.), one of the rising stars in the House of Representatives, proposed a version of the Clinton concept in August, in a new bill called the Medicaid Accountability and Care Act.
The principal advantage of per-capita caps is that they don’t reward profligate states, like New York, that have ratcheted up Medicaid spending on extraneous things in order to get more money from Washington. Instead, the money follows the actual Medicaid patient, wherever he lives. Furthermore, per-capita caps are countercyclical; if the economy is bad, and more people become poor, the federal government would spend more.
“A per capita cap policy would encourage states to manage their programs efficiently,” wrote John Holahan, Joshua Wiener, and David Liska in a 1997 analysis of Clinton’s proposal for the Urban Institute. “The enhanced flexibility proposed by the administration would further aid them in controlling Medicaid expenditures,” and eliminate incentives that states have today to game the system.
Per-capita caps aren’t problem-free. Without other fiscal controls, states might enroll an unexpectedly high number of people into Medicaid, further straining the budget. In addition, Medicaid patients are highly heterogeneous, with the elderly and disabled costing more money than, say, children. The Urban Institute researchers noted that “a single aggregate cap would create incentives to add low-cost enrollees such as children,” and that even dividing patients into broad categories could lead to gaming the system.
Progressive critics should come up with their own solutions
Block-granting Medicaid would lead to a health care policy revolution. We’d finally be able to test out different ways to provide health care to the poor, and focus our energies on replicating the work of those states that did the best job. That flexibility, in turn, could help us improve the way government runs Medicare and other public programs.
Simply throwing more money onto a broken system is fiscally impossible, and doesn’t change the structural incentives that cause Medicaid to deliver such low-quality health care. Personally, I wouldn’t be opposed to a combination of increasing Medicaid’s reimbursements and block-granting the program, though those increased payments would have to be offset by reduced health spending elsewhere.
If progressives have plausible ideas as to how to make Medicaid more efficient, we should take them into account. Clinton’s per-capita cap may be one such idea. But anyone who claims to care about the poor, and accepts the status quo, is consigning the poor to even worse health care than they get today.
UPDATE 1: Paul Howard has published an op-ed in the Wall Street Journal summarizing his Manhattan Institute paper.
UPDATE 2: Former Sen. Tom Daschle (D., S.D.), the former Senate Majority Leader, has endorsed the per-capita cap idea, according to John Wilkerson of Inside Health Policy:
Former Sen. Daschle (D-SD), who was President Obama’s first choice for running HHS, said Thursday (Oct. 4) that Congress should fund states Medicaid programs on a capped per person basis, which is a compromise to Medicaid block grants that some key Republicans have said they would entertain. Daschle told Inside Health Policy that he is “vehemently opposed” to block grants and he does not consider the per capita cap approach as a variation of block grants because it would let states add residents to the Medicaid roles during lousy economies.
Daschle said the per capita cap approach would give states the incentive to improve services with guaranteed benefits. “That’s another key factor here: We’re guaranteeing benefits on the Medicaid program,” he added.
Daschle’s remarks came the morning after President Obama blasted GOP presidential candidate Mitt Romney’s Medicaid block grant proposal as a plan that would cut the program’s funding by 30 percent. During Thursday night’s presidential debate, Romney repeated his long-standing view that block grants would encourage state innovations, but he added that the federal government could “step in” if states get in trouble. Romney’s campaign did not reply to an email asking for an explanation of the intervention policy. The president told Romney that states, while creative, would have a difficult time dealing with a 30 percent cut.
Some Democrats have supported Medicaid per capita caps as an alternative to block grants, but they have been more wary of the idea than have Republicans, even though former Democratic President Bill Clinton tried to reach a compromise with Republicans on such an approach in the latter 1990s
Rep. Mike Burgess (R-TX) told IHP last month that several House Republicans have discussed the per capita idea and he believes it is a proposal that could gain traction, but he said he did not know if it was seriously being considered. Rep. Bill Cassidy (R-LA) is pushing per-person caps in a bill called the Medicaid Accountability and Care Act.
Some Democratic lobbyists say it is doubtful Congress could work out a deal based on Medicaid per capita caps in part because the approach could create bureaucratic nightmares.
But Tom Scully, CMS administrator under President George W. Bush, said the plan would not be that difficult to implement. He said he set up a per-capita cap in Missouri in 2002 and in 2001 Tennessee set up a per capita cap under a Democratic governor. “The idea that it is too complex and undoable is incorrect,” he told IHP. “It has been done, I think in as many as 10 states.”
When asked whether Democrats would go along with per capita caps, Daschle said it’s an approach that would achieve two key goals: guaranteeing benefits and giving states flexibility.
“We know that we have to do something,” he said.
In a separate article, Wilkerson reports that key House Republicans are also open to the per-capita cap idea as a path to compromise on Medicaid reform:
House Republicans have discussed pushing a Medicaid per-person spending cap next year as a possible compromise to the Medicaid block grant proposal in the House-passed budget, according to Rep. Mike Burgess (R-TX), but Democratic lobbyists say it is doubtful Congress could work out a deal in part because per-person caps would create bureaucratic nightmares. Nevertheless, the concept deals with one of the main arguments that Democrats make against block grants, which is that more people need Medicaid during economic downturns and block grants do not account for that counter-cyclical nature of the program.
The concept of capping Medicaid spending per person instead of per state is mostly associated with Republicans — Rep. Bill Cassidy (R-LA) is pushing the approach in a bill called the Medicaid Accountability and Care Act — but former President Bill Clinton also entertained the idea in 1997. When the then GOP-controlled Congress passed a Medicaid block grant bill, Clinton vetoed it, then proposed per-capita caps as a compromise. Clinton and Republicans did not work out their differences, but lobbyists say it’s plausible that a similar proposal could come up next year during deficit-reduction talks.
Burgess told Inside Health Policy that several House Republicans have discussed the idea and he believes it’s a proposal that could gain traction, but he added that he does not know whether it is being seriously considered. He said he likes the idea of money following the person and thinks that it would be a more fair and open way of funding the safety net health care program. However, he said the proposal could create a lot of fights, especially among states, because the approach could lead to some states getting more Medicaid funding than they do now and other states getting less.
Rep. Phil Gingrey (R-GA), who is a member of the GOP Doctors Caucus with Burgess and also is amenable to the idea of per-person caps, echoed the state issue. He said some states have been gaming Medicaid to get more federal money and those states would likely be against a per-capita cap approach.
The National Governors Association in 1997 opposed Clinton’s proposal but an NGA spokesperson said the group does not have a position on Cassidy’s bill or the approach in general. The National Association of Medicaid Directors also does not have a position, NAMD Executive Director Matt Salo said.
It’s not clear how Senate Democrats would respond to a Medicaid per person cap. Sen. Ron Wyden (D-OR), who sponsored a Medicare premium support proposal with GOP vice presidential candidate Paul Ryan (WI), an approach that is in now the House budget, would only say that he opposes Medicaid block grants and declined to discuss per-person caps.
Bruce Leslie, who worked with the White House on per-capita caps as a Senate staffer in 1997 and is now the head of First Focus, said per-person caps are better than block grants, but the policy is unusually difficult to write into law. One of the first problems that would need to be worked out is whether the caps will be nation-wide or by state. If national caps are chosen, states such as New York with higher expenses, would lose out, he said. The policy also would lock in the inefficiencies of states that have done a poor job of rooting out fraud, he added.
Another issue, Leslie said, is that since Medicaid beneficiaries differ significantly, lawmakers likely would try to set higher caps for sicker and disabled beneficiaries. But that would be very difficult to do, would create a lot of bureaucracy, would lead to formula fights among advocates of beneficiaries in different demographics and could allow states to game the system, he said
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Want to know who could possibly be worse for the citizens of America wanting developed world health care than a deeply conservative state of Kansas politician who worked for Kansas State Insurance corporations while an elected pol....Sebelius? That's right, Sylvia Mathews Burwell who is the Clinton Administration executive, Wall Street-loving, Bill Gates Pharmaceutical Empire building RAGING GLOBAL CORPORATE EMPLOYEE!
Burwell was brought on board because Bill and Hillary will move forward with ending Federal Medicaid and Medicare with block grants to states complete with financial caps as a 'compromise to Republicans'. Obama is placing Burwell assuming Hillary will win the 2016 election and move forward with this dismantling of Medicare and Medicaid. Burwell has all the creds needed for the most global corporate rule administrator possible. At her confirmation hearings she told a Republican senator that she thought block grants for Medicaid were a success and that she would do the same with Medicare.
REPUBLICANS OVERWHELMINGLY APPROVED OF BURWELL BECAUSE AS WITH ALL OBAMA POLICY----BLOCK GRANTING IS A REPUBLICAN POLICY TO END AND DEREGULATE HEALTH CARE.
Block granting is actually what Maryland is already doing having received an exemption from Medicare for a few decades, it removes all Federal oversight and accountability and exempts Maryland from the Federal requirements of these programs. What happens it that the level of fraud and corruption soars taking most of the Medicare and Medicaid money to the health institutions' profit with the poor and seniors receiving ever less quality and access. States basically dismantle public health and citizens have no way of knowing what is being done, what health statistics and results are, and where the money actually goes. In Baltimore, these funds are given to non-profits to control elections----to buy loyality-----and to build with taxpayer money what will become private health businesses while the health care for the citizens declines sharply. IT IS A VERY, VERY, VERY BAD POLICY THAT DEREGULATES AND REDUCES QUALITY AND ACCESS. Think about how 80% of Americans may fall into Medicaid at the same time Medicaid becomes block granted.
BURWELL IS THE ULTIMATE GLOBAL CORPORATE WALL STREET INSIDER! PERFECT FOR PRIVITIZING AND DISMANTLING MEDICARE AND MEDICAID!
Sylvia Mathews Burwell To Replace Kathleen Sebelius As U.S. Health And Human Services Secretary
Reuters | By Roberta Rampton Posted: 04/10/2014 10:55 pm EDT Updated: 06/10/2014 5:59 am EDT
WASHINGTON, April 10 (Reuters) - U.S. Health and Human Services Secretary Kathleen Sebelius is resigning after overseeing the botched rollout of President Barack Obama's signature healthcare law, a White House official said on Thursday.
Her departure removes one lightning rod for critics as Obama and nervous Democrats try to retain control of the U.S. Senate in November midterm elections, but Republicans continue to see problems with the Affordable Care Act as a winning issue...................
But Sebelius, a former governor of Kansas, told Obama in early March she wanted to leave the administration, a White House official said.
"She believed that once open enrollment ended it would be the right time to transition the department to new leadership," the official said.
MANAGEMENT CREDENTIALS
Burwell, 48, is no stranger to top-level administrative positions, having served as deputy White House chief of staff during the Clinton administration and in top roles at the Treasury Department and the National Economic Council.
She served at the Office of Management and Budget twice, as deputy director under Jack Lew from 1998 to 2001, and took over as director about a year ago. She helped the administration manage its response to a shutdown of the federal government brought on by a budget battle with Republicans in October.
In the intervening years, she worked at the Bill and Melinda Gates Foundation and as head of the Wal-Mart Foundation.
Burwell "seems to have a strong background in management, and that's what we need now," said Timothy Jost, a healthcare expert who teaches at Washington and Lee University.
"We're over some of the biggest hurdles now, and what we need is somebody who can stay the course."
Her nomination into the contentious position will likely be eased by a Senate rule change last year known as the "nuclear option," which lowers the vote threshold needed to overcome procedural hurdles for confirmation of presidential nominees.
Instead of the previous 60 votes required to override a senator's objection to a nominee, only 51 votes are needed to advance to a final vote under the changes made by Senate Democrats, who currently control the Senate 55 votes to 45.
One of the first challenges for Burwell will be to work with health insurers in the coming months as they set prices for Obamacare plans in 2015. Industry executives have warned that many states could see double-digit increases in monthly premiums as they try to account for the higher proportion of older policyholders who often cost more to cover. Such price hikes would provide fodder for Republican opponents of the law who say it creates financial burdens for individuals and businesses.
She will also be challenged to improve the health insurance exchanges before the next enrollment period begins in November, and with the Treasury Department, implement new penalties for Americans who did not buy health insurance.
Democrats facing tough races in November are pushing for politically palatable changes to the law, while Republicans will push to get rid of it.
"Secretary Sebelius may be gone, but the problems with this law and the impact it's having on our constituents aren't," said Mitch McConnell, the top Republican in the Senate.
"Obamacare has to go, too," McConnell said in a statement...................
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This article does a good job summing what deregulation will do and how WE THE PEOPLE can reverse what neo-liberals and neo-cons are doing to the once #1 ranked health system in the world.
THIS IS LIFE AND DEATH PEOPLE FOR WHAT WILL BECOME 90% OF AMERICANS IF GLOBAL CORPORATIONS HAVE THEIR WAY!
The Affordable Care Act: What to Expect in 2013
Posted: 01/24/2013 3:35 pm EST Updated: 03/26/2013 5:12 am EDT Huffington Post The Affordable Care Act (ACA), crafted in large part by corporate stakeholders who are themselves responsible for the high costs of U.S. health care, is more secure with President Obama's win. But regrettably, the law will fail to control costs or prices, will not provide universal access to care, and at best will provide low value, high premium "insurance" that will still make essential health care unaffordable for many millions of patients and families.
The ACA's fundamental flaw is that it props up an inefficient and exploitative private health insurance industry while not recognizing that deregulated markets can't fix systemic problems of access, costs, quality, equity, accountability and sustainability.
President Obama has gained an impressive victory, and Democrats have held control of the Senate. Most importantly, corporate money, power, lies and deception on the right have not prevailed. But of course, the Republican-controlled House is likely to bring continued political gridlock. Overemphasis on austerity and deficit control threaten Medicare, Medicaid and safety net programs.
Going forward, we can expect to see wild battles across the health care landscape, including these examples:
Health care is just one more example of the 99/1 percent challenge facing the country. These are some of the directions that we, the citizens of this great country, can take in restoring hope that all Americans can gain their rightful access to the health care that they deserve:
Other advanced nations around the world learned many years ago that one or another form of public financing is fundamental to a good health care system. The U.S. remains an outlier among these nations in having the most expensive system that still does not provide universal access to essential health care -- even at that we have variable quality and worse outcomes. It is long overdue to learn from the experience of other countries that have coped more successfully with the same health policy issues that we face in this country.
John Geyman, M.D. is professor emeritus of Family Medicine at the University of Washington, author of Health Care Wars: How Market Ideology and Corporate Power Are Killing Americans, past president of Physicians for a National Health Program (PNHP), and a member of the Institute of Medicine.
WHO SUPPORTS NEO-LIBERALS EVERY ELECTION? LABOR AND JUSTICE ORGANIZATIONS. DO THESE ORGANIZATIONS REALLY WANT TO END ALL OF OUR SAFETY NETS WHEN THEY SUPPORT NEO-LIBERALS?
PLEASE GLANCE THROUGH TO LAST ARTICLE!
Below you see a good summation of the debate over ending Medicaid by sending it to the states as block grants and in some cases a caps policy. You see that Bill and Hillary Clinton are all for deregulating and sending to the states Medicaid but as we heard from Burwell in her confirmation hearing she will do the same for Medicare. THIS IS HOW YOU END THESE FEDERAL PROGRAMS. Now, I've talked about how Medicare Advantage exists to privatize Medicare as well, but cutting almost $1 trillion dollars to force lower payments to doctors is the best plan for ending Medicare as doctors simply will not take patients. That is what block grants end up doing as well.....states slowly defund Medicaid or install hard to meet rules-----like Texas has done to abortion clinics to close them. This is what deregulation of health care looks like.....it will be a mess and the American people will not be able to trust that the quality of care or the person giving them care is reputable. Remember, Medicaid and Medicare cover the poor and seniors and with poverty levels in the US right now at 70%-----these policies will affect almost all people.
WE ALL KNOW THE PROBLEM WITH COST FOR MEDICARE AND MEDICAID IS SYSTEMIC FRAUD AND CORRUPTION. IT TAKES $400 BILLION AND MORE EACH YEAR----ALMOST 1/2 OF EXPENDITURES. SENDING IT TO THE STATES MAKES THAT SOAR.
What neo-liberals Clinton/Obama along with Republicans always say----send it to the states to be run more efficiently-----well, the fraud and corruption comes from the failure of states like Maryland to provide oversight and accountability. What Clinton and Republicans want to do is use block grants and caps to deregulate what quality health care looks like and caps will end the idea of Hippocratic Oath because doctors will no longer do what is required for a person's health but rather what can be done most cheaply.
It is interesting where we see in an article Obama once again saying one thing and doing another-----neo-liberals could care less what they say as they move forward an agenda of dismantling all of the public sector, public rights, and public justice. Obama says NO TO BLOCK GRANTS and uses it against Romney even as he brings Burwell to the Health and Human Services to do just that.
I'll start with the most vulnerable group -----the disabled-----but remember-----your family is most likely to fall into these problems as well. IT IS A SWEEPING ATTEMPT TO END ALL PUBLIC HEALTH.
REMEMBER, TRANS PACIFIC TRADE PACT AND CLINTON AND OBAMA ARE PUSHING AS HARD AS THEY CAN TO DO THIS AROUND THE WORLD----THEY WILL DO IT HERE.
Medicaid Block Grant Information
How will Medicaid Block Grants Impact People with Intellectual and Developmental Disabilities and their Families?
Introduction
The House Budget Resolution for FY 2013 calls for drastic cuts to Medicaid ($810 billion over 10 years) that would fundamentally reshape the program—making it less reliable for the people who depend on it and shifting costs to consumers and to the states.
For millions of people living in poverty, Medicaid is a safety net. For many of the 7 million people with intellectual and developmental disabilities (I/DD), Medicaid is a life line. People with I/DD typically require more complex and costly services than Medicaid recipients without disabilities. Frequently, they need care from several different types of health care providers and they often need the services throughout their lifetimes.
What is a Medicaid “block grant?”
A Medicaid block grant would be a fixed amount of money from the federal government to the states to spend on health care for people who are poor, elderly, or have disabilities with only general rules and very little oversight about the way it is spent.
Based on previous federal block grants and the general statements that House Budget Committee Chairman Paul Ryan has made about the FY 2013 House Budget Resolution, we expect that a Medicaid block grant would:
- cap the amount the federal government spends on Medicaid.
- NOT increase this amount to keep up with health care inflation.
- radically cut the federal share of Medicaid.
All health care spending is growing. Experts claim that it will continue to grow and become an ever larger share of our federal budget. Most Members of Congress are looking for ways to get our fiscal house in order. Some Members of Congress are focusing on the growth of federal spending in the Medicaid program. They believe that block granting Medicaid will save federal dollars. Under a block grant, federal funding for Medicaid would not grow when more people need health services. The challenge of providing health care without any additional federal money to people who are poor, elderly or have disabilities would fall to the states.
What are the most critical Medicaid services for people with I/DD and how does Medicaid pay for them?
The most critical Medicaid services for people with I/DD are:
- Acute care - including hospital care, physician services, and laboratory and x-ray services. These acute care services are mandatory which means they must be provided to everyone who is eligible. States have the option to offer (and most do) prescription drugs, dental, physical therapy, speech therapy, prosthetic devices and other services.
- Long term services and supports - including help getting dressed, taking medication, preparing meals, managing money, getting in and out of bed.
Is Medicaid an entitlement program?
Yes. This means that if a person meets the eligibility requirements (generally poverty, age and/or disability), he or she is entitled to the services available under the state Medicaid program.
What are people with disabilities currently entitled to in the Medicaid program?
Today, each state’s Medicaid program is required by the federal government to provide a minimum level of coverage for the elderly, people with disabilities, and low-income adults and children in order to receive federal matching payments. Minimum services include seeing a doctor, getting x-rays, going to the hospital, receiving care in a nursing home and vaccines for children. Nursing home care is also an entitlement and Medicaid pays for almost half of the long-term care expenditures in this country. It is the primary payer of long-term services and supports for people with I/DD.
What might states do if Medicaid is block granted?
Block grants could force bad choices and cause substantial conflict as groups with diverse needs compete for scarce dollars. Since the services to people with disabilities and the elderly are significantly more costly than health care coverage for children, states could decide to serve fewer costly adults and people with disabilities and focus scarce health care dollars on less costly children. However there is no certain way to know what states will do. Below are possible choices states might make:
- States may reduce coverage of home and community-based services (HCBS) and supports. Most people who need long term services prefer to receive them at home. Over 650,000 people with I/DD receive long-term services paid for by Medicaid. States could decide to stop providing these services or limit the number of people who could get them. There already are over 300,000 people with I/DD on waiting lists for Medicaid home and community-based services. There are 730,000 people with I/DD living with aging caregivers who are approaching the time when they no longer will be able to care for their adult children with I/DD at home. If states stopped providing long-term services for people with I/DD, the waiting lists would grow and the situation for older caregivers would become more dire.
- States may decide to move people into institutions. Under a block grant, rules for providing quality care could be more flexible and conditions in institutions could return to the way they were in the past. With fewer requirements, it may be cheaper for states to care for people with I/DD in large facilities.
- States may reduce eligibility by making it more difficult to meet financial or other criteria. To be eligible for Medicaid, people have to be poor. States could restrict health care services to only the very, very poor.
- States may increase the cost burden on the individuals or family members. States may decide that families should take care of their family members who are elderly, ill or have disabilities. States might decide that sons and daughters should care for their parents when they become frail or ill without any public dollars. In order to get health care, people might have to pay more out of their own pockets. Since people on Medicaid are poor to start with, requiring them to pay for their medical care or long term services and supports could be an insurmountable barrier.
- States may eliminate or reduce the availability of critical services such as personal care, prescription drugs, rehabilitative services, or home and community based waiver programs. All of these services are “optional” under Medicaid meaning that states may choose to provide them under their Medicaid plans or not. If funds become scarcer, states may decide to stop providing these optional services.
- States may slash the amounts they pay to doctors and other providers. It is already very difficult for people using Medicaid to find doctors and other health care providers. Finding a dentist or a specialist, such as a neurologist, is impossible in some communities. If states cut the amount they pay doctors and other providers, those professionals may quit serving people under Medicaid making the problem even worse.
No. Most people with I/DD cannot get medical insurance through an employer because they do not work full time. In fact only 21% of people with all disabilities are working (March 2011). Others cannot find health insurers who will sell them policies because of their pre-existing conditions. Many people with I/DD cannot afford health insurance. Some people with I/DD find that if insurers will sell them policies it does not cover the services they need or the coverage is exorbitantly expensive.
Why are we concerned that services to people with disabilities might be targeted in the states if Medicaid is turned into a block grant?
People with disabilities and the elderly account for most of the Medicaid spending. While children and parents make up about 75 percent of Medicaid enrollees, they account for less than a third of the spending. In contrast, the elderly and individuals with disabilities make up about 25 percent of enrollees but about two-thirds of spending. Medicaid spending per capita in 2009 was $3,442 for families (parents and children) and more than five times higher for the elderly and people with disabilities at $17,763. The elderly and people with disabilities use health care services more often and use more health services and the elderly and people with disabilities are more likely to use long-term services and supports. We are very concerned that states may slash the supports that help people with I/DD live independent, productive lives.
Are block grants cost effective?
A Medicaid block grant doesn’t control the cost of health care which continues to rise as people get older and use more health care services and as the general cost of all health care increases. They do shift more of the cost to that state and likely the individual. Costs may actually rise significantly because people who lose their health care or can’t afford it will stop seeing their doctors or taking their medication. When that happens it makes existing health conditions worse leading to more doctor or hospital visits and more costs down the road and the individual faces more illness and hardship. If home and community based services are reduced it will likely lead to greater levels of costly and unnecessary institutionalization or homelessness. If people are not provided needed services they may not be able to work, learn or function in the community. This creates lost productivity from the individual and family members if they are called upon to provide care when there are no other options.
What can advocates do?
Advocates must make clear to their Members of Congress that block granting Medicaid is not the answer to our nation’s deficit. Advocates must tell their Members what exactly is at stake. The health of people with I/DD may very well be at stake if it becomes more difficult or costly to access needed health services. What will happen if you or your family member loses services under Medicaid or if you have to pay for long term services and supports? Advocates must let their Members know what the biggest concerns are for individuals and families with I/DD if state Medicaid programs are turned into block grants. With less money, would states make it more difficult to become eligible for Medicaid?
- Would they cut benefits?
- Would they cut current levels of spending?
- Would they decide not to cover currently eligible populations?
- Would the states stop serving certain groups of people?
- Would they stop providing entire categories of services?
- Would people with I/DD be able to obtain health care?
- Would people with I/DD have long term services in community settings or would they be forced into institutions?
Please take note at the information below because an article that follows with a pro-block granting view uses this Rhode Island model as proof it works well. As with all individual models-----they fund it well and run it looking nothing like it will look when installed.
[1] Center on Budget and Policy Priorities Rhode Island’s Global Waiver not a Model for How States Would fare under a Medicaid Block Grant, March 2011. Rhode Island’s block grant is held up as a model by some supporters of block grants. However, the state’s fixed amount of federal funds was greater than their normal federal share of Medicaid dollars. Rhode Island’s program does not reflect what likely would happen under block grant proposals currently being discussed. There also is disagreement about the state’s claims of savings under its block grant.
The article below is written by Wall Street so it is slanted to make these ideas look good. I think most people can see through deregulated health care and price caps on health coverage that will have 80% of people attached.
As you see this isn't a Romney and Republican vs the Democrats in Congress thing-----Bill and Hillary Clinton intend to do the same thing Romney is proposing and Obama's new Health and Human Services is tied to both!
Pharma & Healthcare 9/30/2012 @ 11:48PM
Why Block-Granting Medicaid Will Result in Better Health Care for the Poor
Avik Roy , Forbes Staff
In 1997, President Bill Clinton proposed a form of block grants for reforming the Medicaid program that Republicans might learn from.
Mitt Romney and Paul Ryan have proposed an important reform of the Medicaid program: giving federal Medicaid funds directly to states in the form of block grants, and giving the states broad autonomy in how they run those programs. It’s the formula that a Republican Congress and a Democratic President used in 1996 in the landmark welfare reform law of that year. But just as they were then, liberals today are up in arms about block grants, arguing that they will harm the poor. A new paper by my Manhattan Institute colleague Paul Howard proves the opposite: block grants will drive dramatic improvements in Medicaid’s ability to provide quality health care to the poor.
(DISCLOSURE: I am an outside adviser to the Romney campaign on health care issues. The opinions contained herein are mine alone, and do not necessarily correspond to those of the campaign.)
I’ve written often of the very serious problems with the Medicaid program. People on Medicaid have far worse health outcomes than those with private insurance, and in many cases those with no insurance at all. The main cause of Medicaid’s poor outcomes is that it’s very difficult for Medicaid patients to get doctors’ appointments, even for urgent medical problems. This poor access to care, in turn, is caused by the fact that Medicaid severely underpays doctors to care for Medicaid patients. In New York, for example, Medicaid pays 29 percent of what private insurers pay.
There are, in essence, two approaches to making Medicaid better. One would be to leave the program as is, unreformed, but throw more money at it, in order to pay doctors more. The other would be to reform the program, so as to make sure Medicaid dollars are directed toward actual health care, instead of waste, fraud, and abuse.
Doing nothing will worsen Medicaid patients’ access to care
IF YOU THINK THEY INTENDED TO STAY PAT WHEN THEY WROTE THE AFFORDABLE CARE ACT I HAVE SWAMP LAND IN FLORIDA TO SELL YOU!
There’s a third approach, the approach taken by Obamacare: shove 12 to 18 million more people into the existing Medicaid program, with all of its well-known problems, and otherwise standing pat. But that means consigning the poor to even worse health care in coming years.
In July, the State Budget Crisis Task Force—led by Paul Volcker and Richard Ravitch—released an important study, showing how inexorable growth in Medicaid spending is driving states bankrupt, and preventing them from funding other commitments, especially K-12 education. Because of all the constraints and red tape that the federal government places on the Medicaid program, states have one primary option for reducing their Medicaid spending: cutting provider reimbursements even further
States are very restricted in what else they can do. The 1965 Medicaid law severely restricts the ability of states to reform their Medicaid programs in other ways, such as modifying enrollment criteria, or changing the structure of the Medicaid insurance benefit. So they do the one thing they can: pay doctors less.
THIS IS EXACTLY WHAT AFFORDABLE CARE ACT DOES TO BOTH MEDICAID AND MEDICARE FOR THE EXACT REASONS.....MAKE IT HARDER TO FIND DOCTORS.
An annual 50-state survey conducted by the Kaiser Family Foundation, published last October, put it this way: “As in previous years, provider rate restrictions were the commonly reported cost containment strategy…A total of 39 states restricted provider rates in FY 2011 and 46 states reported plans to do so in FY 2012.” In other words, things are going to get worse for Medicaid patients, leading to even worse health outcomes.
Block grants will allow states to dramatically improve Medicaid’s efficiency
Imagine two people, Jack and Jill. I give Jack 100 dollars to buy food, and let him buy that food from wherever he wants. I give Jill the same $100, but only on the condition that Jill buy her food from Zagat-rated sushi restaurants in New York City. I’ve given Jack and Jill an equal amount of money. But Jack will be able to buy a lot more food with the money I’ve given him.
This is precisely the principle that block grants provide to Medicaid. Currently, the federal Medicaid law does the equivalent of giving the $100 to Jill and micromanaging her food consumption. We gave that same $100 to Jack, but he could buy a lot more food with the same money. Indeed, we could give Jack $90, and he would still be able to buy more food than Jill with her salmon sashimi.
Critics of block grants presume, for reasons that aren’t clear, that $100 spent in the current Medicaid program is equivalent to $100 spent by states in a more decentralized way. But as the story of Jack and Jill shows, there are, in theory, substantial efficiencies that can be gained by giving states broad flexibility in the way they care for the poor. Indeed, this is what made block-granting welfare in 1996 such a spectacular success.
As Paul points out in his excellent paper, block grants have been around for a long time. A government commission recommended them as early as 1949. In 1981, “Congress consolidated 50 federal aid programs into nine consolidated block grants” under the Omnibus Budget Reconciliation Act of that year. People in both parties have supported them as a way to put more money under the Jack model than the Jill one.
Three states are showing how block grants could improve Medicaid
Paul reviews how three states—Rhode Island, Indiana, and New York—have taken advantage of more flexibility to save money while delivering better care. (I’ve written previously about the Rhode Island and Indiana experiences.)
At the tail end of the George W. Bush administration, Rhode Island was granted a waiver by the federal government that, in effect, was a block grant: the state was assigned a five-year cap on Medicaid spending of $12.075 billion, in exchange for substantial flexibility to make changes to the program.
The program was a smashing success. Rhode Island was able to save $100 million, and slow the growth of Medicaid from 8 percent per year to 3 percent, by making a few tweaks to their program that they couldn’t before: shifting more Medicaid patients from nursing homes to home- and community-based services; automatically enrolling children with special needs and adults with disabilities into care-management programs; etc.
The best part is that, under a block-grant system, states can identify ways to save money while improving care, and other states can adopt best practices. Indiana, for example, took advantage of a waiver to introduce subsidized health-savings accounts into its Medicaid program, a reform that has been very popular with Medicaid enrollees—one survey showed a 94 percent satisfaction rate—and given Medicaid patients more control over their own health dollars. In theory, HSAs could allow Medicaid enrollees to pay market rates for needed care, improving access and health outcomes.
Bill Clinton’s idea for refining block grants with per-capita caps
Given our trillion-dollar deficits and Obamacare’s huge new spending commitments, we don’t have extra money available to put into the Medicaid program. That’s why Obamacare expanded Medicaid instead of putting all of those newly-subsidized patients onto the law’s more costly insurance exchanges.
There are ways to refine the block grant idea. One idea that Bill Clinton came up in the late 1990s was subjecting Medicaid block grants to a per-capita cap. Think of it as a block grant devolved to the individual, rather than the state, level. Under Clinton’s concept, federal Medicaid spending would be given to states based on the number of Medicaid enrollees in those states, and per-capita Medicaid spending would grow at an indexed rate (GDP plus one percent in his proposal).
Rep. Bill Cassidy (R., La.), one of the rising stars in the House of Representatives, proposed a version of the Clinton concept in August, in a new bill called the Medicaid Accountability and Care Act.
The principal advantage of per-capita caps is that they don’t reward profligate states, like New York, that have ratcheted up Medicaid spending on extraneous things in order to get more money from Washington. Instead, the money follows the actual Medicaid patient, wherever he lives. Furthermore, per-capita caps are countercyclical; if the economy is bad, and more people become poor, the federal government would spend more.
“A per capita cap policy would encourage states to manage their programs efficiently,” wrote John Holahan, Joshua Wiener, and David Liska in a 1997 analysis of Clinton’s proposal for the Urban Institute. “The enhanced flexibility proposed by the administration would further aid them in controlling Medicaid expenditures,” and eliminate incentives that states have today to game the system.
Per-capita caps aren’t problem-free. Without other fiscal controls, states might enroll an unexpectedly high number of people into Medicaid, further straining the budget. In addition, Medicaid patients are highly heterogeneous, with the elderly and disabled costing more money than, say, children. The Urban Institute researchers noted that “a single aggregate cap would create incentives to add low-cost enrollees such as children,” and that even dividing patients into broad categories could lead to gaming the system.
Progressive critics should come up with their own solutions
Block-granting Medicaid would lead to a health care policy revolution. We’d finally be able to test out different ways to provide health care to the poor, and focus our energies on replicating the work of those states that did the best job. That flexibility, in turn, could help us improve the way government runs Medicare and other public programs.
Simply throwing more money onto a broken system is fiscally impossible, and doesn’t change the structural incentives that cause Medicaid to deliver such low-quality health care. Personally, I wouldn’t be opposed to a combination of increasing Medicaid’s reimbursements and block-granting the program, though those increased payments would have to be offset by reduced health spending elsewhere.
If progressives have plausible ideas as to how to make Medicaid more efficient, we should take them into account. Clinton’s per-capita cap may be one such idea. But anyone who claims to care about the poor, and accepts the status quo, is consigning the poor to even worse health care than they get today.
UPDATE 1: Paul Howard has published an op-ed in the Wall Street Journal summarizing his Manhattan Institute paper.
UPDATE 2: Former Sen. Tom Daschle (D., S.D.), the former Senate Majority Leader, has endorsed the per-capita cap idea, according to John Wilkerson of Inside Health Policy:
Former Sen. Daschle (D-SD), who was President Obama’s first choice for running HHS, said Thursday (Oct. 4) that Congress should fund states Medicaid programs on a capped per person basis, which is a compromise to Medicaid block grants that some key Republicans have said they would entertain. Daschle told Inside Health Policy that he is “vehemently opposed” to block grants and he does not consider the per capita cap approach as a variation of block grants because it would let states add residents to the Medicaid roles during lousy economies.
Daschle said the per capita cap approach would give states the incentive to improve services with guaranteed benefits. “That’s another key factor here: We’re guaranteeing benefits on the Medicaid program,” he added.
Daschle’s remarks came the morning after President Obama blasted GOP presidential candidate Mitt Romney’s Medicaid block grant proposal as a plan that would cut the program’s funding by 30 percent. During Thursday night’s presidential debate, Romney repeated his long-standing view that block grants would encourage state innovations, but he added that the federal government could “step in” if states get in trouble. Romney’s campaign did not reply to an email asking for an explanation of the intervention policy. The president told Romney that states, while creative, would have a difficult time dealing with a 30 percent cut.
Some Democrats have supported Medicaid per capita caps as an alternative to block grants, but they have been more wary of the idea than have Republicans, even though former Democratic President Bill Clinton tried to reach a compromise with Republicans on such an approach in the latter 1990s
Rep. Mike Burgess (R-TX) told IHP last month that several House Republicans have discussed the per capita idea and he believes it is a proposal that could gain traction, but he said he did not know if it was seriously being considered. Rep. Bill Cassidy (R-LA) is pushing per-person caps in a bill called the Medicaid Accountability and Care Act.
Some Democratic lobbyists say it is doubtful Congress could work out a deal based on Medicaid per capita caps in part because the approach could create bureaucratic nightmares.
But Tom Scully, CMS administrator under President George W. Bush, said the plan would not be that difficult to implement. He said he set up a per-capita cap in Missouri in 2002 and in 2001 Tennessee set up a per capita cap under a Democratic governor. “The idea that it is too complex and undoable is incorrect,” he told IHP. “It has been done, I think in as many as 10 states.”
When asked whether Democrats would go along with per capita caps, Daschle said it’s an approach that would achieve two key goals: guaranteeing benefits and giving states flexibility.
“We know that we have to do something,” he said.
In a separate article, Wilkerson reports that key House Republicans are also open to the per-capita cap idea as a path to compromise on Medicaid reform:
House Republicans have discussed pushing a Medicaid per-person spending cap next year as a possible compromise to the Medicaid block grant proposal in the House-passed budget, according to Rep. Mike Burgess (R-TX), but Democratic lobbyists say it is doubtful Congress could work out a deal in part because per-person caps would create bureaucratic nightmares. Nevertheless, the concept deals with one of the main arguments that Democrats make against block grants, which is that more people need Medicaid during economic downturns and block grants do not account for that counter-cyclical nature of the program.
The concept of capping Medicaid spending per person instead of per state is mostly associated with Republicans — Rep. Bill Cassidy (R-LA) is pushing the approach in a bill called the Medicaid Accountability and Care Act — but former President Bill Clinton also entertained the idea in 1997. When the then GOP-controlled Congress passed a Medicaid block grant bill, Clinton vetoed it, then proposed per-capita caps as a compromise. Clinton and Republicans did not work out their differences, but lobbyists say it’s plausible that a similar proposal could come up next year during deficit-reduction talks.
Burgess told Inside Health Policy that several House Republicans have discussed the idea and he believes it’s a proposal that could gain traction, but he added that he does not know whether it is being seriously considered. He said he likes the idea of money following the person and thinks that it would be a more fair and open way of funding the safety net health care program. However, he said the proposal could create a lot of fights, especially among states, because the approach could lead to some states getting more Medicaid funding than they do now and other states getting less.
Rep. Phil Gingrey (R-GA), who is a member of the GOP Doctors Caucus with Burgess and also is amenable to the idea of per-person caps, echoed the state issue. He said some states have been gaming Medicaid to get more federal money and those states would likely be against a per-capita cap approach.
The National Governors Association in 1997 opposed Clinton’s proposal but an NGA spokesperson said the group does not have a position on Cassidy’s bill or the approach in general. The National Association of Medicaid Directors also does not have a position, NAMD Executive Director Matt Salo said.
It’s not clear how Senate Democrats would respond to a Medicaid per person cap. Sen. Ron Wyden (D-OR), who sponsored a Medicare premium support proposal with GOP vice presidential candidate Paul Ryan (WI), an approach that is in now the House budget, would only say that he opposes Medicaid block grants and declined to discuss per-person caps.
Bruce Leslie, who worked with the White House on per-capita caps as a Senate staffer in 1997 and is now the head of First Focus, said per-person caps are better than block grants, but the policy is unusually difficult to write into law. One of the first problems that would need to be worked out is whether the caps will be nation-wide or by state. If national caps are chosen, states such as New York with higher expenses, would lose out, he said. The policy also would lock in the inefficiencies of states that have done a poor job of rooting out fraud, he added.
Another issue, Leslie said, is that since Medicaid beneficiaries differ significantly, lawmakers likely would try to set higher caps for sicker and disabled beneficiaries. But that would be very difficult to do, would create a lot of bureaucracy, would lead to formula fights among advocates of beneficiaries in different demographics and could allow states to game the system, he said
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Want to know who could possibly be worse for the citizens of America wanting developed world health care than a deeply conservative state of Kansas politician who worked for Kansas State Insurance corporations while an elected pol....Sebelius? That's right, Sylvia Mathews Burwell who is the Clinton Administration executive, Wall Street-loving, Bill Gates Pharmaceutical Empire building RAGING GLOBAL CORPORATE EMPLOYEE!
Burwell was brought on board because Bill and Hillary will move forward with ending Federal Medicaid and Medicare with block grants to states complete with financial caps as a 'compromise to Republicans'. Obama is placing Burwell assuming Hillary will win the 2016 election and move forward with this dismantling of Medicare and Medicaid. Burwell has all the creds needed for the most global corporate rule administrator possible. At her confirmation hearings she told a Republican senator that she thought block grants for Medicaid were a success and that she would do the same with Medicare.
REPUBLICANS OVERWHELMINGLY APPROVED OF BURWELL BECAUSE AS WITH ALL OBAMA POLICY----BLOCK GRANTING IS A REPUBLICAN POLICY TO END AND DEREGULATE HEALTH CARE.
Block granting is actually what Maryland is already doing having received an exemption from Medicare for a few decades, it removes all Federal oversight and accountability and exempts Maryland from the Federal requirements of these programs. What happens it that the level of fraud and corruption soars taking most of the Medicare and Medicaid money to the health institutions' profit with the poor and seniors receiving ever less quality and access. States basically dismantle public health and citizens have no way of knowing what is being done, what health statistics and results are, and where the money actually goes. In Baltimore, these funds are given to non-profits to control elections----to buy loyality-----and to build with taxpayer money what will become private health businesses while the health care for the citizens declines sharply. IT IS A VERY, VERY, VERY BAD POLICY THAT DEREGULATES AND REDUCES QUALITY AND ACCESS. Think about how 80% of Americans may fall into Medicaid at the same time Medicaid becomes block granted.
BURWELL IS THE ULTIMATE GLOBAL CORPORATE WALL STREET INSIDER! PERFECT FOR PRIVITIZING AND DISMANTLING MEDICARE AND MEDICAID!
Sylvia Mathews Burwell To Replace Kathleen Sebelius As U.S. Health And Human Services Secretary
Reuters | By Roberta Rampton Posted: 04/10/2014 10:55 pm EDT Updated: 06/10/2014 5:59 am EDT
WASHINGTON, April 10 (Reuters) - U.S. Health and Human Services Secretary Kathleen Sebelius is resigning after overseeing the botched rollout of President Barack Obama's signature healthcare law, a White House official said on Thursday.
Her departure removes one lightning rod for critics as Obama and nervous Democrats try to retain control of the U.S. Senate in November midterm elections, but Republicans continue to see problems with the Affordable Care Act as a winning issue...................
But Sebelius, a former governor of Kansas, told Obama in early March she wanted to leave the administration, a White House official said.
"She believed that once open enrollment ended it would be the right time to transition the department to new leadership," the official said.
MANAGEMENT CREDENTIALS
Burwell, 48, is no stranger to top-level administrative positions, having served as deputy White House chief of staff during the Clinton administration and in top roles at the Treasury Department and the National Economic Council.
She served at the Office of Management and Budget twice, as deputy director under Jack Lew from 1998 to 2001, and took over as director about a year ago. She helped the administration manage its response to a shutdown of the federal government brought on by a budget battle with Republicans in October.
In the intervening years, she worked at the Bill and Melinda Gates Foundation and as head of the Wal-Mart Foundation.
Burwell "seems to have a strong background in management, and that's what we need now," said Timothy Jost, a healthcare expert who teaches at Washington and Lee University.
"We're over some of the biggest hurdles now, and what we need is somebody who can stay the course."
Her nomination into the contentious position will likely be eased by a Senate rule change last year known as the "nuclear option," which lowers the vote threshold needed to overcome procedural hurdles for confirmation of presidential nominees.
Instead of the previous 60 votes required to override a senator's objection to a nominee, only 51 votes are needed to advance to a final vote under the changes made by Senate Democrats, who currently control the Senate 55 votes to 45.
One of the first challenges for Burwell will be to work with health insurers in the coming months as they set prices for Obamacare plans in 2015. Industry executives have warned that many states could see double-digit increases in monthly premiums as they try to account for the higher proportion of older policyholders who often cost more to cover. Such price hikes would provide fodder for Republican opponents of the law who say it creates financial burdens for individuals and businesses.
She will also be challenged to improve the health insurance exchanges before the next enrollment period begins in November, and with the Treasury Department, implement new penalties for Americans who did not buy health insurance.
Democrats facing tough races in November are pushing for politically palatable changes to the law, while Republicans will push to get rid of it.
"Secretary Sebelius may be gone, but the problems with this law and the impact it's having on our constituents aren't," said Mitch McConnell, the top Republican in the Senate.
"Obamacare has to go, too," McConnell said in a statement...................
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This article does a good job summing what deregulation will do and how WE THE PEOPLE can reverse what neo-liberals and neo-cons are doing to the once #1 ranked health system in the world.
THIS IS LIFE AND DEATH PEOPLE FOR WHAT WILL BECOME 90% OF AMERICANS IF GLOBAL CORPORATIONS HAVE THEIR WAY!
The Affordable Care Act: What to Expect in 2013
Posted: 01/24/2013 3:35 pm EST Updated: 03/26/2013 5:12 am EDT Huffington Post The Affordable Care Act (ACA), crafted in large part by corporate stakeholders who are themselves responsible for the high costs of U.S. health care, is more secure with President Obama's win. But regrettably, the law will fail to control costs or prices, will not provide universal access to care, and at best will provide low value, high premium "insurance" that will still make essential health care unaffordable for many millions of patients and families.
The ACA's fundamental flaw is that it props up an inefficient and exploitative private health insurance industry while not recognizing that deregulated markets can't fix systemic problems of access, costs, quality, equity, accountability and sustainability.
President Obama has gained an impressive victory, and Democrats have held control of the Senate. Most importantly, corporate money, power, lies and deception on the right have not prevailed. But of course, the Republican-controlled House is likely to bring continued political gridlock. Overemphasis on austerity and deficit control threaten Medicare, Medicaid and safety net programs.
Going forward, we can expect to see wild battles across the health care landscape, including these examples:
- Continued mergers among the major players, including insurance companies, hospital systems, medical groups and others, which will end up increasing costs and prices while limiting patients' choices of physician and hospital.
- Continued lobbying by the insurance industry to mold accountable care organizations and insurance exchanges in their interests (i.e. cherry pick enrollees and pass along sicker patients to public programs).
- Further privatization and exploitation of Medicare and Medicaid.
- Efforts by insurers to limit definitions of minimal essential benefits.
- Further fragmentation and increasing bureaucracy of our market-based health care system with worse health outcomes.
Health care is just one more example of the 99/1 percent challenge facing the country. These are some of the directions that we, the citizens of this great country, can take in restoring hope that all Americans can gain their rightful access to the health care that they deserve:
- Speaking out, individually and collectively, at community, state and federal levels to expose the abuses and cruelty of what passes for health care in its under-regulated state.
- Fighting for a defined benefit program that covers all Americans in a single risk pool with full choice of physicians, other health professionals and institutions. (H.R. 676)
- Supporting efforts at the state level for single-payer financing in the event that reform may first need to be demonstrated at the state level before a national program can be passed by Congress.
- Pushing for a more responsible government oversight of health care at state and federal levels to oversee health care, including an independent, well funded national institute to deal with coverage and cost-effectiveness issues on the basis of scientific evidence, not upon which profit-based interest group can scream the loudest.
- Supporting and participating in divestiture efforts against abusive insurers and other stakeholders in the health care marketplace.
Other advanced nations around the world learned many years ago that one or another form of public financing is fundamental to a good health care system. The U.S. remains an outlier among these nations in having the most expensive system that still does not provide universal access to essential health care -- even at that we have variable quality and worse outcomes. It is long overdue to learn from the experience of other countries that have coped more successfully with the same health policy issues that we face in this country.
John Geyman, M.D. is professor emeritus of Family Medicine at the University of Washington, author of Health Care Wars: How Market Ideology and Corporate Power Are Killing Americans, past president of Physicians for a National Health Program (PNHP), and a member of the Institute of Medicine.
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