Tag Archives: Medicaid

Medicaid Work Requirements Are Detrimental

Previous posts in this blog about Medicaid work requirements, especially in the State of Arkansas, suggested that they would be harmful to recipients of Medicaid benefits. Arkansas was the first state to implement work requirements last June.

In an exhaustive article out today from the New England Journal of Medicine, the authors found that requiring Medicaid beneficiaries to work had a detrimental effect on health insurance coverage in the initial 6 months of the policy but no significant change in employment.

Lack of awareness and confusion, the report states, about the reporting requirements were common, which may explain why thousands of persons lost coverage even though more than 95% of the target population appeared to meet the requirements or qualified for an exemption.

The conclusion of the report found that in its first 6 months, work requirements in Arkansas were associated with a significant loss of Medicaid coverage and rise in the percentage of uninsured persons.

The authors found no significant changes in employment associated with the policy, and more than 95% of persons who were targeted by the policy already met the requirement or should have been exempt.

Since the article is quite long, I have summarized the results here, but the full report can be found by clicking here.

It would appear that the goal of forcing Medicaid beneficiaries to go back to work has more downsides than upsides, but since this is being implemented by a group of puritanical, work-obsessed, economic libertarian politicians, reality has overcome their ideological disgust at giving people social benefits without expecting something in return — namely requiring low-income people to find a job in order to be covered for health care.

Isn’t it time we leave the 17th century and its puritan ethics behind and provide every American, rich or poor, with universal health care, with no strings attached? After all, that is what every other Western democracy does.

Voters Tuning Out of Health Care Debates

Axios reported yesterday that American voters are tuning out of the health care debates dominating Washington, the presidential campaign, and the politically active talking about Medicare for All and other proposals, according to an article by Drew Altman.

Axios conducted six focus groups in three states, Texas, Florida and Pennsylvania. It was facilitated by the Kaiser Family Foundation’s director of Polling and Survey Research. The focus groups consisted of independent, Republican, and Democratic voters in several swing states and districts.

They were only aware of candidates’ and elected officials’ proposals on health care, but they did not see them as relevant to their struggles to pay medical bills or navigating the health care system.

Each of the six focus groups had between 8 and 10 people who are regular voters and said that health care will be an important issue for them in the 2020 election for President.

Here are the takeaways from the focus groups:

  • These voters are not tuned into the details — or even the broad outlines — of the health policy debates going on in Washington and the campaign, even though they say health care will be at least somewhat important to their vote.
  • Many had never heard the term “Medicare for all,” and very few had heard about Medicare or Medicaid buy-in proposals, or Medicaid and Affordable Care Act state block grant plans like the one included in President Trump’s proposed budget.
  • When asked what they knew about Medicare for all, few offered any description beyond “everyone gets Medicare,” and almost no one associated the term with a single-payer system or national health plan.
  • When asked about ACA repeal, participants almost universally felt that Republicans did not have a plan to replace the law.
  • When voters in the groups were read even basic descriptions of some proposals to expand government coverage, many thought they sounded complicated and like a lot of red tape.
  • They also worried about how such plans might strain the current system and threaten their own ability to keep seeing providers they like and trust.

Most of the voters in these groups did not see any of the current proposals from either side of the aisle as solutions to their top problems: namely paying for care or navigating the insurance system and red tape.

The debates on health care have gotten too far into the weeds and are too complex and complicated for the average voter to understand, let alone follow at this early stage of the presidential campaign.

The debate will become more meaningful, the article contends, when they see stark differences between the health plan of the Democratic nominee and Trump. This way, they will be able to focus more on what those differences mean for themselves and the country.

Here is the comment posted in response by Don McCanne:

Although we should be cautious about trying to draw Great Truths from half a dozen focus groups, we should be concerned about what these groups revealed about their understanding of the basis of the problems that they experience with our health care system.

They see problems with navigating the health care system and with paying their medical bills. But when offered solutions for these problems they show little understanding of even basic health policy, and they seem to be influenced more by political memes expressing a distrust of government, complexity of public solutions, and government interference with their interactions with the health care system.

A particularly important example of this is, “When asked what they knew about Medicare for all… almost no one associated the term with a single-payer system or national health plan.”

This lack of sophistication leaves them unaware that the government Medicare program is far more deserving of our trust than the private insurers (“surprise medical bills” anyone?), that a government program that includes everyone though a publicly funded universal risk pool is far less complex than a multitude of private insurers with various complex rules for accessing and paying for care, and that a single payer system interferes less since the patient has free choices in health care whereas the private plans are more restrictive of benefits while limiting coverage to their contracted provider lists (a minute fraction of the physicians and hospitals available throughout the nation).

Health policy is complicated, but the message for single payer Medicare for All need not be: enrollment for life, free choice of physicians and hospitals and other health care professionals and institutions, and automatic payment by our own public program. The focus groups already understand that the Republicans do not have a replacement plan, but what they do not understand is that only the single payer model of Medicare for All meets these goals whereas the ACA/public option Medicare for Some often leaves them exposed to the access and affordability issues they already face.

Again, single payer Medicare for All means:

  • Never have to change insurers
  • Free choice always of doctors and hospitals
  • No medical bills since care has been prepaid through our taxes.

None of these are features of either the Republican proposals or the Democratic ACA/public option proposals. It’s a simple message. Let’s do our best to see that the American voter understands it.

Medicaid Work Requirements in the Courts

Long-time readers of this blog will recall that I discussed Medicaid Work Requirements being proposed by the current neo-fascist regime in Washington.

This discussion was found in the following posts: Arkansas Medicaid Work Requirement Failing Out of the Gate, Nation’s First Medicaid Work Requirement Sheds Thousands From Rolls In Arkansas, Arkansas drops 3,815 more Medicaid enrollees over work requirement – Modern Healthcare, Michigan threatens to repeal Medicaid expansion if work requirements not approved | Healthcare Dive, and Medicaid Work Requirements Worsen Health,

Now comes a few new posts from several sources, that expands on the subject, especially regarding the way the courts are responding to the administration’s desire to impose draconian work requirements on what is essentially a health care program, and not a make-work program.

Note: I am awaiting enrollment into Medicaid.

The following articles all involve the Arkansas Medicaid Work Requirement case, and one judge in federal court has already decided that Congress clearly intended Medicaid to be a health program, and not a work program.

Here are the links to the articles:

Fierce Healthcare

Health Affairs Today

Center on Budget and Policy Priorities

Arkansas Times

Don McCanne commented after posting the CBPP and Arkansas Times articles as follows:

“What kind of policy is it that when low-income individuals are unable to find jobs, the state punishes them by taking away their health care? The judge hearing the Medicaid work requirement case in Arkansas agrees, “that’s not the purpose of Medicaid”

Shouldn’t we instead have a public policy that says that anyone who needs health care should be able to receive it? That is not the case now, even though we are already spending enough to guarantee health care for everyone. We could do that merely by enacting and implementing a single payer Medicare for All program, and it doesn’t have to cost us any more than we are already spending.

It would be great if our government also supported more effective policies to ensure that every capable person has employment opportunities, but depriving people of their health care is not an effective work program, as Arkansas has demonstrated.

How can it be that we even tolerate such a cruel government policy?”
Yes, how can we tolerate such a cruel government policy, when it has been government policy
decades to divide the health care system into silos, so that each demographic, the elderly, the
poor, children, families of service members, etc., are served by health care programs that are
put in silos, which no other Western nation does. Even our veterans get put into a special silo
called the VA, and that has been a disaster for our veterans seeking medical care.
We must stop playing games with people’s lives. We must also stop trying to impose outdated
work requirements reminiscent of the Puritan settlers, and does not deal with the reality of the
21st century job market that makes many poor people ineligible for the kind of employment
that would get them off of Medicaid altogether. Until that changes, we need Medicare for All,
and to stop dividing people into silos.

Provider Reimbursements under Medicare for All

Yesterday, Healthcare Dive.com posted an article outlining the various proposals for a public health insurance program.

While it did not cover new ground, there was one part that made me curious as to why it was a big deal. It had to do with provider reimbursements under Medicare and Medicaid being lower, and if a single payer system was enacted, providers would see less in reimbursements.

Here is what Healthcare Dive said:

“Providers are already taking up arms against any expanded public health plan. Since Medicare and Medicaid tend to pay less than private payers, more government reimbursement would mean less money in hospitals’ coffers.”

Really?

Excuse me if I sound a little confused, but if you expand the number of persons covered for health insurance, even though you are being paid less under such a plan, won’t you still make more money than if the number of persons covered was smaller?

So for example, if x number of Americans are covered by Medicare and Medicaid, and the providers are reimbursed at a high amount without a single payer plan, wouldn’t covering all 300+ million Americans under single payer, mean that providers would make just about the same, or maybe even more than before single payer?

If providers were paid $1,000 for each of 200 covered individuals in the current system, totaling $20,000 for example, then by raising the number of covered under Medicare for All to let’s say, 3000, providers would be paid $800 for each covered person, then they would make $2.4 million. And for arguments sake, if there were fifty providers, then without MFA they each would make $400 each, but with MFA, they would make $48,000 each. Not bad.

So why are providers up in arms? Could it be that they are engaged in a financial version of adverse selection by wanting to only take private insurance reimbursements, and not single payer?

Or maybe that is part of the problem with our health care system? Pure, unadulterated greed.

Medicare for All – the three versions – Managed Care Matters

Hot on the heels of my post this morning, Health Care Is Not a Market, comes another post from Joe Paduda.

This time he discusses the three versions of Medicare for All that have already been introduced, or soon will be.

However, there is one item that I have with Joe’s version of MFA that I believe is not a viable option – Medicaid for All.

As we have seen in Kentucky, one governor, a Democrat, expanded Medicaid in his state, only to see his successor, a Republican, eliminate it, thereby tossing millions of Kentuckians to lose health care right after getting it,

All it takes is one gubernatorial or legislative election, and millions in that state will lose coverage.

The better option is Medicare for All, since the federal government, and not the states will finance it.

Anyway, here is Joe’s article: 

There is no consensus about what MFA is – and that makes it really easy for supporters and opponents to convince the uninformed it is great or awful. They do that by picking out whatever they think you’ll love/hate – … Continue reading Medicare for All – the three versions

Source: Medicare for All – the three versions – Managed Care Matters

Health Care Is Not a Market

For the next twenty-one months, there will be a national debate carried on during the presidential campaign regarding the direction this country will take about providing health care to all Americans.

However, to anyone who reads the articles, posts and comments on the social media site, LinkedIn, that debate is already occurring, and most of it is one-sided against Medicare for All/Single Payer. The individuals conducting this debate are for the most part in the health care field, as either physicians, pharmaceutical industry employees, hospital systems executives, insurance company executives, and so on.

We also find employee benefits specialists and other consultants to the health care industry, plus many academics in the health care space, and many general business people commenting, parroting the talking points from right-wing media.

That is why I re-posted articles from my fellow blogger, Joe Paduda last week and yesterday,  who is infinitely more knowledgeable than I am on the subject, and has far more experience in the health care field, that not only predicts Medicare for All (or what he would like to see, Medicaid for All), but has vigorously defended it and explained it to those who have misconceptions.

For that, I am grateful, and will continue to acknowledge his work on my blog. But what has caused me to write this article is the fact that most of the criticism of Medicare for All/Single Payer is because those individuals who are posting or commenting, are defending their turf.

I get that. They get paid to do that, or they depend on the current system to pay their salaries, so naturally they are against anything that would harm that relationship.

But what really gets me is that they are deciding that they have the right to tell the rest of us that we must continue to experience this broken, complex and complicated system just so that they can make money. And that they have a right to prevent us from getting lower cost health care that provides better outcomes and does not leave millions under-insured or uninsured.

However, not all these individuals are doing this because of their jobs. Some are doing so because they are wedded to an economic and political ideology based on the free market as the answer to every social issue, including health care. They argue that if we only had a true free market, competitive health care system, the costs would come down.

But as we have seen with the rise in prices for many medications such as insulin and other life-saving drugs, the free market companies have jacked up the prices simply because they can, and because lobbyists for the pharmaceutical industry have forced Congress to pass a law forbidding the government from negotiating prices, as other nation’s governments do.

Yet, no other Western country has such a system, nor are they copying ours as it exists today. On the contrary, they have universal health care for their citizens, and by all measures, their systems are cheaper to run, and have better outcomes.

None of these countries can be considered “Socialist” countries, and even the most anti-Socialist, anti-Communist British Prime Minister, Winston Churchill said the following, “Our policy is to create a national health service in order to ensure that everybody in the country irrespective of means, age, sex or occupation shall have equal opportunities to benefit from the best and most up-to-date medical and allied services available.”

Notice that Sir Winston did not say, free market competition. He knew that competition is fine for selling automobiles, clothing, food, and other goods and services. But not health care.

He also said that you can always count on Americans to do the right thing, after they have tried everything else. We’ve tried the free market in health care, and drug prices and other medical prices are through the roof.

However, another thing they have not done, and I believe none of the other OECD countries have done about health care, is to divide the “market” into silos such as the elderly with Medicare, the poor with Medicaid, children with CHIP, veterans with the VA, and their families with Tricare, etc.

No, they pay for all their citizens from a global budget, and do not distinguish between age level, income level, or service in the armed forces.

And their systems do not restrict what medical care their people receive, so that no only do they have medical care, but dental care, vision care, and hearing care. It is comprehensive. And if they have the money to pay for it, they can purchase private health insurance for everything else.

In the run-up to the debate and vote in the UK on Brexit, the point was raised that while Britain was a member of the EU, their retirees who went to Spain to retire, never had to buy insurance because the Spanish providers would bill the NHS.

However, once Britain leaves the EU, they will have to buy insurance privately, because the NHS won’t pay for it. But not all retirees can afford private insurance, so many British citizens will have a problem.

As I have mentioned before in this blog, I was diagnosed with ESRD, and am paying $400 every three months for Medicare Part B. I was doing so while spending down money I received after my mother passed away in 2017. My brother and I sold her assets and used that money to purchase property so that she could go on Medicaid, and eventually into a nursing home when the time came for her to be cared for around the clock.

Since my diagnosis, and prior, I was not working, so spending $400 every three months, and paying for many of my meds, has been difficult. I am getting help with some of the meds, and one is free because my local supermarket chain, Publix gives it for free (Amlodipine).

I hope to be on Medicaid soon, but would much rather see me and my fellow Americans get Medicare for All, and not have to pay so much for it. (a side note: we have seen that Medicaid expansion has been haphazard, or reversed, even when the government is paying 90% of it)

So why are we not doing what everyone else does? For one thing, greed. Drug companies led by individuals like Martin Shkreli, who is now enjoying the hospitality of the federal government, and others are not evil, they are following the dictates of the free market that many are advocating we need. No thanks.

For another, Wall Street has sold the health care sector as another profit center that creates a huge return on investment by investors and shareholders in these companies and hospital systems. Consolidation in health care is no different than if two non-health care companies merge, or one company buys another for a strategic advantage in the marketplace.

There’s that word again: market. We already have a free market health care system, that is why is it broken. What we need is finance health care by the government and leave the providing of health care private. That’s what most other countries do.

So those of you standing in the way of Medicare for All/Single Payer, be advised. We are not going to let you deny us what is a right and not a privilege. We will not let you deny us what every other major Western country gives its people: universal, single payer health care.

Your time is nearly up.

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