Obamacare Medicaid Expansion

Georgia, like many southern states, has rejected the Obamacare Medicaid expansion and with good reason. We can’t afford it.Obamacare Medicaid expansion

Critics say this hurts the poor (no real argument there) but there is only so much taxpayer dollars to spread around and we can’t fund everything for everyone.


Money Doesn’t Grow on Trees

The folks in DC say “No problem. We have a printing press. How much do you need?”.

Informed citizens know this is a joke, and a bad one at that. Eventually all those borrowed funds will need to be repaid and the party is over. Problem is, we are the ones that have to pick up the empty beer bottles and empty the ashtrays after Washington has partied on OUR money.

Half the states have either rejected Obamacare Medicaid expansion or are undecided.

Problem with that is, Obamacare is counting heavily on Medicaid expansion to cover 15 – 20 million who may currently be uninsured.

Even though DC has offered to fund the expansion, it is only for a few years.


PCIP Failure

Of course they also gave us PCIP to cover folks with pre-existing conditions and the program worked reasonably well until it ran out of money and the had to close the program for new applicants 9 months before 2014 when carriers are required to issue a policy to anyone, regardless of health.


Arkansas Private Medicaid Option

So now Arkansas, a red state for sure, has extended an olive branch to DC by suggesting a private Medicaid option.

The Arkansas plan would allow Medicaid beneficiaries to use the newly created Obamacare health insurance exchanges to purchase a plan of their choice using (our) federal tax dollars.

This is a stroke of genius because it put’s the monkey on the back of the folks in DC that created this mess and keeps the state funds out of it.

But it is not without issues.

Commercial insurers’ doctor networks are generally wider than Medicaid networks. Entrée for Medicaid patients could improve access to care and prevent minor illnesses from spiraling into expensive hospitalizations.

It could also reduce care disruptions for those whose incomes fluctuate, shifting them between Medicaid and the subsidized exchanges.

At the same time, adding thousands of Medicaid members to the exchanges could reduce the risk that a few chronically ill patients would sharply drive up exchange premiums

Kaiser Health News

All this sounds good in theory, but the truth is, most carriers have  opted out of the federal health insurance exchanges. The ones that will play will offer NARROW provider networks and SKINNY drug formulary coverage.

Private insurance plans offered on the exchange will look more like HMO plans than the traditional PPO plans private consumers are accustomed to.

So far HHS has only agreed to review the proposed Obamacare Medicaid expansion private option and there is no guarantee it will be accepted.

Then there is this . . .

 Medicaid typically pays hospitals and doctors much less than average. A beneficiary costing the government $6,000 a year for Medicaid would cost $9,000 on a private plan on the exchange, the Congressional Budget Office has estimated. On the other hand, Arkansas officials have suggested that competition among insurers and providers for Medicaid patients could keep the cost from being prohibitive or even save money eventually.

Again, sounds good on paper but the envisioned competition among carriers for exchange based business will not materialize.

You can bank on that.

The Check is in the Mail

States are having trouble making ends meet and a lot of that is due to mandates from Washington. Funding for expanded SCHIP and Medicaid was supposed to come (at least in part) from D.C., but it seems the folks in Washington are finally realizing they have already spent the money given to us by the Chinese and the corner loan shark is not willing to float them money.

On top of it all, Obama is threatening to kick some B.P. butt and Helen Thomas is off visiting some of her Jewish friends in Palestine.

And now this.

The New York Times reports that at least 30 states are in the hole for Medicaid unless Congress sends them more money. What most folks may not know is the party is about to end. All that is left now is for our children and grandchildren to empty the ashtrays and pick up the left over beer bottles from the Obama celebration of letting the good times roll on someone else’s dime.

COBRA subsidies, funding for Medicaid and SCHIP was paid for with checks kited from Washington. Most states figured they didn’t have to pare back or raise taxes as long as Obamabucks were flowing.

Unless Congress approves more Medicaid spending, which at this point seems unlikely, the states are going to have some serious funding problems. Some of our Congress critters have taken off their party hats and are threatening to sit on their hands should new votes come up for spending bills. This applies to folks with a “D” as well as those with an “R” after their name. The voter revolt is becoming quite vocal over all the spending and heads are already rolling with more to follow.

Gov. Edward G. Rendell of Pennsylvania, for instance, penciled $850 million in federal Medicaid assistance into the revenue side of his state’s ledger, reducing its projected shortfall to $1.2 billion. The only way to compensate for the loss, he said in an interview, would be to lay off at least 20,000 government workers, including teachers and police officers, at a time when the state is starting to add jobs.

“It would actually kill everything the stimulus has done,” said Mr. Rendell, a Democrat. “It would be enormously destructive.”

Yes, “stimulus” really has a nice ring to it until the voters realize that (1) it isn’t working and (2) eventually someone will have to pay for this mess. Jobs created or saved sounds good until you realize that 95% of the new jobs were part time Census workers. Toto has pulled back the curtain to reveal the Wizard is a fake.

The Medicaid provision, which would extend assistance first granted in last year’s stimulus package, was considered such a sure bet by many governors and legislative leaders that they prematurely included the money in their budgeting. But under pressure from conservative Democrats to rein in deficit spending, House leaders in late May eliminated $24 billion in aid to states from a tax and jobs bill that was approved and forwarded to the Senate.

This is called betting on the come. If you know your opponent it can work to your advantage in poker, but it doesn’t work so well when the bank is busted and the folks you are playing against decide to call it a night.

Although the federal Medicaid share varies by state, the stimulus act raised it to an average of 66 percent, from 57 percent, according to the Kaiser Family Foundation.

The reimbursement increase was limited to a 27-month period that ends on Dec. 31. Almost as soon as it took effect, governors began fretting about the fiscal precipice they would face when the enhanced payments ended. In February, governors from 42 states and several territories signed a letter to Congressional leaders pleading for a six-month extension.

But with the public alarmed about deficit spending, House leaders found that they could not muster the Democratic votes needed to pass the tax and jobs bill without jettisoning several expensive components.

So what happens now?

Seems that in addition to folks in DC worrying about getting laid off the same fate might await those at the state level. This is not a good year to be an incumbent.

Obamacare Puts 14 Million on Welfare

The CBO projects 14,000,000,000 will go on welfare if the Baucus health care bill is enacted. According to the Directors blog:

Under the proposal, the share of legal nonelderly residents with insurance coverage would rise from about 83 percent currently to about 94 percent. Roughly 23 million people would purchase their own coverage through the new insurance exchanges, and there would be roughly 14 million more enrollees in Medicaid and CHIP than is projected under current law. Relative to currently projected levels, the number of people either purchasing individual coverage outside the exchanges or obtaining coverage through employers would decline by several million.

So 14 million, some of whom may have private coverage now, will find themselves getting second class  health care through the welfare system. Americans who voted for change you can believe in will find themselves at welfare offices signing up for SCHIP (Peachcare in Georgia) and Medicaid.

Since Medicaid and SCHIP pay providers 20 – 25% less than private health insurance moving in this direction will actually be less expensive than putting these people on private plans. That means Congress is pretty shrewd in playing to those who are looking for a handout from the working class. Just like Oliver Twist, those who receive care through Medicaid will be coming back asking “Please, may I have some more?”

In most areas less than half the physicians are willing to treat Medicaid patients, so one wonders if putting more people on welfare medicine will put a bigger strain on the system.

Currently, those of us with private insurance are paying higher medical bills, and in turn, higher health insurance premiums, to subsidize the shortfall that results from treating Medicaid patients. As more go on the dole, expect the cost of our health care to rise and likewise so will health insurance premiums.

Medicaid and SCHIP are federal programs that are at least partially funded at the state level. Each state will have to raise taxes to cover the cost of expanded Medicaid and SCHIP roles. How much is anyone’s guess but Tennessee’s Democratic Governor Bredesen had this observation.

Gov. Phil Bredesen warned Tuesday that pending federal health care legislation could cost Tennessee far more than the $735 million “best estimate” his administration previously has cited.

The $735 million would stretch over five years, but “in addition, there are huge unknowns for the states in this reform,” Gov. Bredesen said, estimating that those costs, if realized, could exceed another $3 billion from 2014 to 2019.

You need to know that any estimates by the CBO do not include cost shifting and tax increases at the state level. Neither do they include increases in health insurance premiums.

When you add it all up you have to wonder just how much this whale is actually going to cost the taxpayers. Just another stupid government trick.

Health Care Reform vs. Medicaid

How will we pay for health care reform when we can’t even cover the cost of Medicaid? Conservative estimates put the cost of health care reform at $1 trillion. Mr. Fixit has said he will not sign legislation expanding government intervention in health care unless it is deficit neutral.

Well then explain this.

A key provision of health care reform is expanding the roles of Medicaid. Providing free health care for the poor sounds great until you realize that Medicaid at the federal level is on life support. States aren’t any better off and some projections put Medicaid deficits at the state level in the $200 billion range over the next 3 years.

According to the AARP, Between 1988 and 1993 Medicaid spending grew from $26 billion to an estimated $139.8 billion. Between 1995 and 2002, Medicaid spending is projected to grow by $150.8 billion; this translates into an average annual growth rate of 10.1 percent. In order to reduce government spending, the federal government is now requiring states to try to recover some of the money they spend on Medicaid beneficiaries.

That is spending at the federal level. According to the Kaiser Foundation total Medicaid spending (federal and state) was $319 billion in 2007. Of that total, $110 billion came from state taxes.

Direct federal funds for Medicaid ballooned to $209 billion from 2002 to 2007.

Congress saw the problem in Medicaid deficits as far back as 1993 and decided to do something about it by taxing the poor.

Since passage of the Omnibus Budget Reconciliation Act of 1993 (OBRA ’93), Congress has required states to try to recover the cost of Medicaid benefits from the estates of certain nursing home residents and older persons receiving home- and community-based services. This law applies to individuals who were age 55 or older when they received Medicaid.

OBRA only addresses estate recovery for those who receive nursing home and home based care but why stop there?

The estate recovery provision was voluntary and many states ignored it until the federal government threatened to withhold matching Medicaid funds unless the states started enforcing estate recovery. All 50 states have now enacted their own provisions for estate recovery.

If your nursing care was paid for by Medicaid when you die the state files a lien against your estates and becomes a first line creditor by filing a claim in probate court. Any money recovered by the state is to be returned to the federal government, so the state is just a bill collector.

If the federal government and states can’t afford Medicaid now, how will they afford it when health care reform expands the roll of Medicaid? Why isn’t anyone asking this question?

Smaller cars, bigger health insurance, Poppa Washington.

Hidden Taxes Fund Health Care Reform

Don’t you just love it when politicians tell you there will be no new taxes to fund a new program? It’s as if they can make money magically appear out of thin air (and to an extent they do).

But why is it no one is really asking the tough questions. You know, such as “how will WE pay for it?”

A new hidden tax went into effect today. Not related to health care but supposedly designed to stimulate the economy. The hidden tax comes in the form of a $0.75 per hour increase in the minimum wage.

The DOL says the increase will lead to new spending which will help the economy.

Right . . .

What if the employer lay’s off workers, or fails to hire new workers, or cut’s back on hours worked by minimum wage employees? How does this help the economy?

Or maybe the employer doesn’t do any of that but instead raises prices to compensate for the higher wage?

Since most of the folks in Washington have never owned a business, much less held a real job, they would not understand this basic fact.

There are also hidden taxes in health care reform. Things they are not telling you about.

Consider this tidbit from Greg Johnson of the Knoxville News Sentinel.

A key component to the Obama plan is the expansion of Medicaid. Since the federal government funds part of Medicaid and the states pay a portion, any increase would necessarily mean more costs at the state level. “Medicaid is a poor vehicle for expanding coverage,” Bredesen told the Times. “It’s not health care reform to dump more money into Medicaid.”

With a $1 trillion federal price tag, how much might Obama’s health care reform cost at the state level? Sen. Lamar Alexander, R-Tenn., offered an estimate last month. “This bill is so expensive, it will literally bankrupt states,” Alexander said. “Just the expansion of Medicaid in the bill could cost Tennessee $1.2 billion a year by 2015, according to the state Medicaid director.”

$1.2 billion is a lot to ask from 6.2 million residents of Tennessee, and 2015 isn’t that far off.

If Obama strong-arms enough of his reckless, feckless colleagues in Congress to pass this bill, how might Tennessee come up with $1.2 billion? “This is about the amount of money,” Alexander said, “a new 10 percent state income tax would raise.”

10% is hefty as well.

Guess the goal would be to earn no income and avoid paying the tax. Of course if you did that you would qualify for Medicaid.

Smaller cars, bigger health insurance, Poppa Washington.

White House Wants Control of Medicare

In an effort to seize more power, Mr. Fixit has asked Congress to relinquish control of price setting for Medicare reimbursement to the White House. According to Breitbart,

The proposal would allow an independent advisory board to recommend changes in Medicare reimbursement rates for doctors, hospitals and other providers. If the president approved the recommendations, Congress could still vote to reject them altogether. But Congress could not approve some recommendations and reject others.

Currently, Medicare reimbursement rates vary from region to region. Key lawmakers often get involved in setting local rates, a practice the Obama administration plan would end.

The current Medicare reimbursement rate is the least of any “insured” plan other than Medicaid. Many doctors limit the number of Medicare patients they will treat or refuse to accept any Medicare patients at all.

In most areas, about half of all doctors do not accept Medicare assignment.

Currently, Medicare reimbursements are scheduled to be reduced by 21% in January, 2010. This means doc’s who currently accept Medicare assignment would receive a 21% pay cut starting in January of next year if the scheduled cuts are put in place. The most likely result would be even fewer doctor’s willing to treat Medicare patients.

If the White House is given supreme power over Medicare reimbursement one has to wonder how deep the cuts will be and how few doctor’s and hospitals would be willing to accept Medicare patients.

Almost one out of three American’s is covered by Medicare or Medicaid. (If Medicare reimbursement is cut so would Medicaid. Reimbursement rates for Medicaid is 10 – 14% less than Medicare levels).

The good news is, any reduction in reimbursement for M/M reduces the tax bill for those who pay Medicare taxes.

The bad news is, reductions in M/M reimbursement means fewer medical providers willing to treat those patients and more out of pocket for people on M/M.

Making Health Care Affordable for Everyone

Seems like everyone complains that it is impossible to find affordable health insurance in Georgia. Now a fellow blogger has some rather drastic suggestions that have merit. His tongue is firmly planted in his cheek . . .

Mr. Fixit seems hell-bent on destroying the best health care system in the world and lowering costs, so here are some solutions put forth by Medical Pastiche.

Outlaw all forms of health insurance. [Read more…]

The S.S. Titanic

Some in Washington want to put all of us in Medicare. That might not be such a good idea.

You see, Medicare is expected to run out of money in 2017.

Contributing factors?

Millions fewer people are working and paying the taxes that support the programs; yet health care costs are continuing to soar, millions of baby boomers have begun receiving Social Security retirement benefits, and Americans are living longer.

Medicare expenses are now expected to surpass Social Security’s in 2028.

Did you catch that?

The cost of running Medicare is expected to surpass the cost of Social Security in less than 20 years. [Read more…]

Doctor Shortage

Want to see a Georgia doctor?

Take a number.

This is especially so if you are a new patient, do not have health insurance, have Medicare, Medicaid or PeachCare. So if we are having problems now, what happens when it is free?

Obama administration officials, alarmed at doctor shortages, are looking for ways to increase the number of physicians to meet the needs of an aging population and millions of uninsured people who would gain coverage under legislation championed by the president.

You can’t just push a button and “poof” you have new doctors. It takes years to “grow” a new crop of docs.

One proposal — to increase Medicare payments to general practitioners, at the expense of high-paid specialists — has touched off a lobbying fight.

This is called squeezing the balloon.

Cut reimbursement to one sector to cover the cost of services for another sector. It is also known as robbing Peter to pay Paul.

That has never worked. Why would Obama-man think it will work now? [Read more…]

Perdue Cold Cuts

Here at Georgia Health Insurance we like to stay on top how the state is spending our tax dollars. Like most states, and the federal government, we are looking at steep budget cuts to keep from going under. All areas are subject to the knife. Roads, schools and even Medicaid are trying to find ways to keep rolling on less money.

When you cut Medicaid, everyone loses, both rich and poor.

Governor Perdue has proposed a 10% cut in Medicaid funding to hospitals. This translates into a loss of almost $81 million.

The proposed Medicaid cut is expected to be magnified since hospitals will lose $2 in federal matching funds for every $1 in state Medicaid money that gets cut, said Kevin Bloye, spokesman for the Georgia Hospital Association.

“When you add the federal matching dollars,” Bloye said, “hospitals could lose an additional $120 million.”

Most hospitals lose money serving Medicaid patients, so this only makes it worse.

The Medicaid cuts could be the “last straw” for some hospitals in the state, industry insiders said.

Hospitals are suffering from rocketing unpaid medical bills, a decline in high margin elective procedures, and the growing rolls of uninsured.

So what happens when hospitals refuse to accept Medicaid patients?

Everyone loses.

“We can see hospital closures, we can see major damage to large hospital systems and we can see individual physicians who are getting out of the business, all because we didn’t take the stimulus package money and use it directly for Medicaid,” hospital lobbyist Jimmy Lewis said.

Oh yeah. About that Spendulus money.

The stimulus money doesn’t come “close” to offsetting the tax revenue hit facing Georgia, Brantley said.

So even Obamaman can’t save us.

Having fun?