Tag Archives: Medicaid Expansion

No Socialists Here

Dear Insurance company execs, pharmaceutical company execs, employee benefits consultants and executives, Wall Street investors, and all other stakeholders in the current dysfunctional, broken, complex, complicated, and bloated mess called the US health care system.

You have heard many politicians, and journalists, not to mention your own peers, or even you yourselves label the push for Medicare for All as “Socialism.”

We even have the Administrator of CMS, Seema Verma, calling it, and the public option plan,  “radical and dangerous for the country” recently when she spoke to the Better Medicare Alliance’s Medicare Advantage Summit in Washington, D.C.

Her solution, and probably yours as well, is to keep selling Medicare Advantage plans, which only makes the current system worse.

So, to help you get over your fear and loathing of Socialism, and to prove to you that the only reason why the US is the only Western, industrial nation to not provide its citizens with universal health care is because you are making money off of other people’s health, or lack thereof.

You are doing so, because you are greedy. There I said it. Now I hope you will pay attention to the following graphic:

Do you see any socialist countries? Do you see any radical and dangerous regimes that are hostile to the interests of the US? Well, maybe Slovenia. After all, they did send us Melania and her illegal family.

But back to the case at hand. I defy any of you hotshots in the health care space to prove to me that all of these Capitalist, free-market countries are flaming Reds, or even a bit Pinko.

You can’t, because it is not true. You and those who call Medicare for All, Single Payer, or even the so-called “public option” radical, just don’t want the government to interfere with your looting the pockets of the American people for your financial gain.

And that is why we are the only country with an “X”, instead of a check mark below our name.

16,000 Unnecessary Deaths Tied to Failure to Expand Medicaid

The Los Angeles Times reported Monday that a new study found that Medicaid expansion brought appreciable improvements in health to enrollees, but also that full expansion nationwide would have averted 15,600 deaths among the vulnerable Medicaid-eligible population.

This is in contrast to the view of opponents of Medicaid expansion who have said that lack of evidence that enrollment in Medicaid improves health and saves lives, and therefore they believed that expansion was a waste of money.

In the 22 mostly red states that refused expansion, the cause of the 15,600 deaths of their state’s residents was attributed to failure to expand.

“This highlights an ongoing cost to non-adoption that should be relevant to both state policymakers and their constituents,” the authors of the study said.

Fourteen states are still holding out, States such as Wyoming and South Dakota, the article states, have a warped sense of “freedom.” States such as Maine and Louisiana, who have had a change in governors from Republican to Democrat, have recently adopted expansion.

medicaid

Fourteen states still resist Medicaid expansion, at great cost to their residents (Kaiser Family Foundation)

The article takes a dim view of the entire rationale for refusing to expand Medicaid, and cites a few noted Conservative voices against the entire idea of expansion and Medicaid itself.

Conservatives have worked hard to depict Medicaid as ineffective, the article reports. They’ve done so, it continues,  by overinterpreting limited studies such as a 2013 study of a Medicaid expansion in Oregon.

Critics focused on the researchers’ finding of “no significant improvements in measured physical health outcomes in the first 2 years” of expansion, but they overlooked the findings that the expansion did “increase use of healthcare services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain.”

Conservative health policy Avik Roy has crowed, the article states, that the result “calls into question the $450 billion a year we spend on Medicaid, and the fact that Obamacare throws 11 million more Americans into this broken program.”

Another right-wing critic of Medicaid expansion, and not to mention, also of Medicare for All, and now more recently, the public option for Medicare, is CMS Administrator Seema Verma, a Trump flunky.

(Credit: Getty Images )  Picture worth a thousand words was never more true. What a piece of work!

Verma has argued that the expansion hasn’t been a success despite its enrollment figures and has been a leader in undermining the program by allowing states to impose premiums, work requirements and punitive disenrollments on patients. (Her efforts have been blocked by a federal judge, for now.)

This is why advocates for Medicare for All are so passionate and determined, in the face of even the slightest opposition to improving the health and lives of millions of Americans for small changes to our nation’s health care system.

Failure to expand Medicaid, failure to enact universal health care, even if it is a public option, is challenged from the right for morally indefensible and reprehensible reasons.

The cry of “freedom” from conservatives is a smoke-screen to hid their true purpose. To dismantle all social programs and funnel that money to the wealthy and corporations, as they have already done with the Trump tax giveaway.

Now they are trying to cut three million Americans off of food stamps.

All these schemes have one purpose in mind, to kill off their most ardent supporters in Southern and Midwestern states that continue to vote for these sociopaths. To them, freedom means, freedom for a company to profit off of your misfortune, whether that misfortune is due to poor diet, poor personal habits such as smoking and drug abuse, and poor health outcomes due to poverty and economic distress.

Naturally, any attempt to improve the health and lives of the poor, black or white, or Latino, etc., is viewed as “Socialism” and is deemed bad for the country, as Ms. Verma did this week to the Better Medicare Alliance’s Medicare Advantage Summit in Washington, D.C.

No, it’s not bad for the country. It’s bad for the profits of the insurance companies, the pharmaceutical companies, the benefit managers industry, the health care consultants, and Wall Street investors.

Wanting to cut of food stamps, fail to expand even Medicaid, tightening rules for who is eligible for these programs, is not only bad for the health of average Americans, it is bad for the economic vitality of the nation in an era of global competition.

The men and women at Trump rallies are angry, but they are angry at the wrong people. The clown on the stage is the person they really should be angry at, and his entire swamp of “the best people.”

1 in 5 rural hospitals at risk of closing, Navigant says | Healthcare Dive

Readers of this blog will recall that I wrote four earlier posts about the closing of rural hospitals, so the article from Healthcare Dive.com comes as no surprise.

Previous posts ( https://wp.me/p2QJfz-GeL, https://wp.me/p2QJfz-IZ3, https://wp.me/p2QJfz-N0u, and https://wp.me/p2QJfz-QSn) go into greater detail about the seriousness of the issue.

But once again, we have to remind the readers that until we enact Single Payer health care, more Americans will lose access to medical care at rural hospitals.

Here is the article:

More than 60% of those facilities are “highly essential” to the heath and economic well-being of their communities, according to a new report.

Source: 1 in 5 rural hospitals at risk of closing, Navigant says | Healthcare Dive

Arkansas drops 3,815 more Medicaid enrollees over work requirement – Modern Healthcare

Modern Healthcare reported yesterday that the State of Arkansas dropped almost 4,000 of its citizens from the Medicaid expansion because of failure to comply with work requirements the state enacted months ago.

The following summary and link is provided:

Nearly 4,000 Arkansans lost their Medicaid expansion coverage in October because they didn’t comply with the state’s new work requirement. Another 8,462 low-income adults lost benefits in the previous two months.

Source: Arkansas drops 3,815 more Medicaid enrollees over work requirement – Modern Healthcare

Midterm Mashup

Well, the 2018 Midterm elections are over, and the analysis is beginning as to what this all means.

For those who wanted to send a message to the Russian puppet in Washington, the election meant that the House of Representatives will be controlled for the next two years starting in January by the Democrats.

For the Republicans, it means a greater control of the Senate, with at least one race, the one in my current state of Florida undecided and headed for a recount, as per state law.

However, there were many defeats for the party of Obama, Bill Clinton, Jimmy Carter, LBJ. JFK, Truman and FDR. Andrew Gillum lost to a nobody for governor of Florida who is connected to the Orangutan by an umbilical cord. Beto O’Rourke made a valiant, if futile effort against the worse person to hold a Senate seat, Lyin’ Ted Cruz. And a few Democratic senators lost seats in Indiana, Missouri and North Dakota.

But as far as health care is concerned, the change in the leadership of the House of Representatives means that the ACA is safe for another two years. and Medicare and Medicaid will not be cut, as the Senate Majority Leader has indicated he wanted to do.

Medicaid, in particular, came out of the Midterms a little better than expected before the election, as the following posts from Healthcare Dive, Joe Paduda, and Health Affairs reported this morning.

First up, Healthcare Dive, who reported that Red states say ‘yes’ to Medicaid . Idaho, Utah, and Nebraska said yes to expansion; Montana said no.

Joe Paduda echoed that in his post, “And the big winner of the 2018 Midterms is…Medicaid“. However, Joe stated that results in Montana were not final; yet, they had decided to expand Medicaid two years ago, but the vote was temporary, and yesterday’s vote was to make it permanent.

And lastly, Health Affairs reported in “What the 2018 Midterm Elections Means for Health Care” that besides blocking repeal of the ACA, Democrats may tackle drug prices, preexisting conditions protections, Opioids, Medicare for All, Surprise bills (unexpected charges from a hospital visit). regulatory oversight, extenders such as MACRA, Medicaid Disproportionate Share Hospital (DSH) payments, and Medicaid expansion, especially since gubernatorial wins in Maine, Kansas, and Wisconsin will make expansion more likely in those states.

Nation’s First Medicaid Work Requirement Sheds Thousands From Rolls In Arkansas

Last month, you may recall, I posted an article about Medicaid work requirements in Arkansas from an article in Health Affairs.

Today, Health Affairs posted a follow-up article that reported that thousands are being shed from the Medicaid rolls in Arkansas.

According to the article, the Arkansas Department of Human Services officials announced on Sept. 12 that 4,353 people who were enrolled in the state’s Medicaid expansion program had been locked out of coverage for failing to comply with the work requirement for three months.

The agency has said those people will have until October 5 to apply for a good cause exemption if they were unable to access an online reporting portal because of network server issues that affected it and other agencies.

Source: Nation’s First Medicaid Work Requirement Sheds Thousands From Rolls In Arkansas

Rural Hospitals to Fail If Medicaid Expansion Ends

In April of 2015, I wrote the following post, Hospital Closures Due to Failure to Expand Medicaid.

This morning, Health Affairs posted a brief, Ending Medicaid Expansion Would Cause Rural Hospitals to Go Under.

As the current regime in Washington, and its allies in Congress slowly dismantle the ACA, rolling back Medicaid expansion will lead to rural hospitals closing, and rural patients being forced to travel long distances to get to a hospital, or to forgo medical at all.

What impact this will have on the entire health care sector is too early to tell, and what this may mean for workers’ comp, is also speculative, but it can’t be good if hospitals in the heartland go out of business.

Some way to make America great again. On the backs of, and on the health of, rural Americans who voted for this clown.

ACA Repeal Opens Up Medical Travel: A Second Look

Note: Here is Laura’s second article on repeal of the ACA and its’ impact on medical travel. She breaks the article down by areas of the healthcare industry that will be affected by repeal and that might benefit from medical travel.

Repeal of Affordable Care Act Impacts International Medical Travel
by Laura Carabello

wphealthcarenews.com- The repeal of the Affordable Care Act (ACA) has been met with considerable market uncertainty. As the transition gets underway, many Americans will be scrambling to access affordable, quality care.

Fortunately, the international medical travel industry -“Travel for Treatment” – may finally gain the attention it deserves from the American public and U.S. employers. Experts predict that the number of Americans traveling abroad for medical care or episodes of treatment is expected to increase 25 percent annually over the next decade.

Medical travelers are likely to come from every market sector: the growing ranks of uninsured individuals, self-insured employers facing higher healthcare expenditures, disenfranchised Medicaid beneficiaries, as well as Medicare enrollees with high out-of-pocket expenditures and the loss of coverage for preventive care.

Individual Consumers
Once “minimum essential healthcare coverage” is no longer mandated, the burden of payment will transfer onto healthcare providers and systems that will be forced to continue cost shifting onto the backs of paying customers.

Fewer insurance companies will be willing to underwrite coverage in the exchanges. In fact, many will leave the individual marketplaces altogether because of the potential loss of federal subsidies for both beneficiaries and insurance companies themselves.

Burdened by hefty cost-shifting, more Americans will be forced to pay out of their own pockets for surgeries or treatments in the U.S. Those who can afford a plane ticket will find it increasingly attractive to travel outside the country for quality, affordable options, such as joint replacement, cardio-thoracic surgery, oncology, bariatrics, and a host of other medical procedures, including treatment for Hepatitis C.

Low-Income (Medicaid) and Seniors (Medicare)
For Medicaid beneficiaries who remained optimistic that their home state would offer expanded coverage, their prospects look dim. The unraveling of the ACA will leave millions of the poorest and sickest Americans without insurance. Many states may either abandon Medicaid expansion or be forced to significantly redesign their programs to ensure that individuals below 400 percent of the federal poverty level can receive affordable healthcare coverage and services.

While these low-income families may not have cash reserves to fund expensive care in the U.S., they might be able to gather the resources to access needed surgeries overseas – and pay less than half of the US rates. Those who have emigrated from Latin American countries, in particular, will take advantage of opportunities to travel to their homelands to gain access to care that is substantially less expensive, and in a familiar setting.

The 57 million senior citizens and disabled Americans enrolled in Medicare could also benefit from accessing international medical travel. Under a full repeal of the ACA, seniors face higher deductibles and co-payments for their Part A, which covers hospital stays, and higher premiums and deductibles for Part B, which pays for doctor visits and other services. Medicare enrollees may also lose some of their free preventative benefits, such as screenings for breast and colorectal cancer, heart disease and diabetes. The opportunity to access quality care at lower costs – plus prescription drugs that are sold at far lower price points outside the US – present attractive options.

Employers
Healthcare will continue to be driven through employers, and cost pressures will push high-deductible plans, risk-based contracting and consumerism. In the United States today, even a negotiated, discounted rate for a total knee replacement at a local hospital may well exceed $45,000, $60,000, or more. The bottom line for self-insured employers – the coverage model that now dominates the marketplace: even after factoring in the cost of travel and accommodations for the patient and the companion, as well as waiving deductibles and co-pays as incentives to program adoption, the savings on surgical procedures such as joint replacement are significant.

Employers will also be more likely to send workers to emerging COEs outside the country in light of the many partnerships that are underway between US providers and foreign hospitals. These collaborative programs are bringing American ingenuity, sophisticated technology and advanced levels of care to institutions throughout the world.

Quality and safety standards at many institutions are now equal to or exceed US benchmarks. Many foreign hospitals are accredited by Joint Commission International, an extension of the US-based Joint Commission. Select hospitals outside the country adhere to US clinical protocols.

In fact, one organization that serves self-insured employers – North American Specialty Hospital in Cancun – even offers U.S. surgeons with US malpractice insurance who perform pre- and post-operative care in the US and then travel to Cancun for surgery. This ensures continuous engagement and continuity of care.

Hospitals
The ACA has contributed to hospitals experiencing higher volumes of insured patients, but those volumes would drop with the law’s repeal. It could also cause fewer people to keep prescription coverage, which would be modestly negative for the pharmaceutical industry.

Experts believe the majority of primary care physicians are open to changes in the law but overwhelmingly oppose full repeal, according to a survey published in The New England Journal of Medicine.

Insurance coverage for the 20 million people who obtained insurance from the exchanges sparked growth in patient numbers for hospitals, which offset lower payments. Without this, hospitals can expect deepening economic problems. This could lead to higher prices, and greater impetus among individuals to seek medical care outside of the U.S.

Key Destinations for International Medical Travel
With the growing ranks of uninsured, medical travel options are likely to emerge as a critical solution to healthcare cost woes. Hospitals and providers in nearby locations such as Latin America – known as the LAC Region – are likely to become destinations of choice: less expensive travel expenses, reduced language barriers, and cultural familiarity. Individuals and employers will require guidance in terms of choosing the right providers and determining costs to overcome the challenges that lie ahead.

To view the original article, click here.

Low-Income Uninsured Declines Due to ACA Expansion: Kentucky

Richard’s Note: This is my 250th post, although not all of them were written by me, and some of them are just infograms; nevertheless, this is an important milestone. It shows that with dogged determination, in the face of heavy odds and criticism, one can persevere and be insightful at the same time. My only wish is that more people would read this blog, and that it would be taken more seriously. One does not need a title to be taken seriously. Just ask Donald Trump.

As reported today in Health Affairs, Kentucky, which was one of two Southern states to expand Medicaid in 2013, saw a sharp decline in the percentage of uninsured from 35 percent at the end of 2013 to 11 percent in late 2014.

This decline was part of a study that was completed before the new Kentucky governor, Matt Bevins, a Tea Party lackey, announced that he would discontinue the expansion.

The study used data from the Behavioral Risk Factor Surveillance System, an annual survey conducted by the Centers for Disease Control and Prevention. Residents of Missouri, Tennessee, and Virginia, three neighboring states not expanding Medicaid eligibility, served as study controls.

Some of the other study findings revealed declines in the number of people with unmet medical needs and lacking a regular source of health care.

But now that the new governor has discontinued the expansion, it is quite probable that rates of uninsurance will once again climb, as those who gained insurance under the ACA, will more than likely have it taken away from them.

What this means for the health care system in Kentucky, and in the other states that expanded Medicaid, should their states elect more Matt Bevins, is that people who one did not have insurance, will find themselves back in the same position before the ACA.

As I wrote back in May of last year, in my article, “Failure to Expand Medicaid Could Lead to Cost-Shift to Work Comp“, states such as Florida (my state), Texas (naturally), Virginia (legislature said no, governor wants it), Wisconsin (Scott (I hate unions) Walker, and others, are likely to see such cost-shifting.

Adding Kentucky to that mix will only make matters worse. Why the health care industry in general, and the workers’ comp industry in particular, does not explore ALL possible options to providing health care to low-income and injured workers, is beyond me.

But to leave out one particular option because some judge won’t order it (do doctors order executions?), or because some people think that medical care outside the three mile limit of the US is sub-standard, or because they like the status quo and are fooling themselves into believing that some new program or scheme will fix the problem?

And to tell your industry that those “ideas” are new trends without even trying that one particular option, cannot be called “outfront ideas”. It is just more of the same.

Readers of this blog know what that option is…it is part of the reason this blog exists, and why it will continue to exist. We must open our health care options to every conceivable possibility, no matter how far fetched or “out there” it is. It is a law of economics if you can find a product or service at lower cost, and at equal or better quality somewhere else, you will buy it. That seems to work for everything else, but health care.

 

 

 

Workers’ Comp Goes Federal: An Update

The other day, I wrote a post that said that state Medicaid programs will be able to recover all of the proceeds from a settlement that were expended on behalf of a beneficiary.

My reporting of MaryRose Reaston’s article garnered some very positive comments from some of my readers.

Yet, today, my fellow blogger Joe Paduda countered MaryRose’s article, and stated that “No, ACA has not ‘overstepped its bounds‘”.

According to Joe, the efforts by the states are just that, state-based, and they are allowed and enabled by federal legislation…separate and distinct from the ACA.

Joe cites an article written by Michael Stack, Principal of Amaxx LLC that summarizes Medicaid recovery in workers’ comp cases.

As Joe reports, Michael noted that the legislation that allows Medicaid to pursue settlements was part of the Medicare Secondary Payer Act, a part of the 2013 budget bill.

Normally, when I write about some issue someone else wrote about, I never have to provide my readers with an update that challenges the original author. Generally, my updates are just that, updates that add to the discussion. This is not the case here.

So just to be fair to everyone, I decided to correct the situation by writing a follow-up. I trust my readers will understand that I did not mean to mislead or take only one side.