The Moral Healthcare Blog

The price of Medicaid expansion opt-outs: $53.3 billion

The Supreme Court decided way back in June that the health law’s expansion of Medicaid was optional rather than required. That decision, it appears, comes with a hefty price tag: $53.3 billion.

The National Association of Public Hospitals estimates that, in light of the decision, the United States will spend as much as $53.3 billion more on bills that go unpaid by the uninsured. Their analysis uses data from the Congressional Budget Office, which estimates that six million to10 million fewer Americans will gain insurance through Medicaid after the Supreme Court decision.

“Congress certainly didn’t foresee this level of uninsured and uncompensated care when it enacted the ACA,” says NAPH president Bruce Seigel.

Keep in mind, this isn’t necessarily $53.3 billion in new spending. It’s more like a cost shift. Those who would have had their bills paid by the federal government (under Medicaid) could now have the costs covered by local governments and hospitals, which tend to foot the bill for many of the health care services that go unpaid.

The Congressional Budget Office estimates that, over the course of a decade, states opting out of the Medicaid expansion – and not drawing down funds from Washington – will save the federal government $84 billion.

It’s also a cost shift to those with private insurance, as hospitals charge a bit more to clients with coverage to recoup their losses on the uninsured. One study estimated that cost shifting raises annual insurance premiums by as much as 1.7 percent, or $80 annually.

Why I Am Pro-Life – NYTimes.com

In my world, you don’t get to call yourself “pro-life” and be against common-sense gun control — like banning public access to the kind of semiautomatic assault rifle, designed for warfare, that was used recently in a Colorado theater. You don’t get to call yourself “pro-life” and want to shut down the Environmental Protection Agency, which ensures clean air and clean water, prevents childhood asthma, preserves biodiversity and combats climate change that could disrupt every life on the planet. You don’t get to call yourself “pro-life” and oppose programs like Head Start that provide basic education, health and nutrition for the most disadvantaged children. You can call yourself a “pro-conception-to-birth, indifferent-to-life conservative.” I will never refer to someone who pickets Planned Parenthood but lobbies against common-sense gun laws as “pro-life.”

“Pro-life” can mean only one thing: “respect for the sanctity of life.” And there is no way that respect for the sanctity of life can mean we are obligated to protect every fertilized egg in a woman’s body, no matter how that egg got fertilized, but we are not obligated to protect every living person from being shot with a concealed automatic weapon. I have no respect for someone who relies on voodoo science to declare that a woman’s body can distinguish a “legitimate” rape, but then declares — when 99 percent of all climate scientists conclude that climate change poses a danger to the sanctity of all life on the planet — that global warming is just a hoax.

The term “pro-life” should be a shorthand for respect for the sanctity of life. But I will not let that label apply to people for whom sanctity for life begins at conception and ends at birth. What about the rest of life? Respect for the sanctity of life, if you believe that it begins at conception, cannot end at birth. That radical narrowing of our concern for the sanctity of life is leading to terrible distortions in our society.

Medicaid on the Ballot – NYTimes.com

But one thing is clear: If [Romney] wins, Medicaid — which now covers more than 50 million Americans, and which President Obama would expand further as part of his health reform — will face savage cuts. Estimates suggest that a Romney victory would deny health insurance to about 45 million people who would have coverage if he lost, with two-thirds of that difference due to the assault on Medicaid.

….

So, about coverage: most Medicaid beneficiaries are indeed relatively young (because older people are covered by Medicare) and relatively poor (because eligibility for Medicaid, unlike Medicare, is determined by need). But more than nine million Americans benefit from both Medicare and Medicaid, and elderly or disabled beneficiaries account for the majority of Medicaid’s costs. And contrary to what you may have heard, the great majority of Medicaid beneficiaries are in working families.

For those who get coverage through the program, Medicaid is a much-needed form of financial aid. It is also, quite literally, a lifesaver. Mr. Romney has said that a lack of health insurance doesn’t kill people in America; oh yes, it does, and states that expand Medicaid coverage show striking drops in mortality.

So Medicaid does a vast amount of good. But at what cost? There’s a widespread perception, gleefully fed by right-wing politicians and propagandists, that Medicaid has “runaway” costs. But the truth is just the opposite. While costs grew rapidly in 2009-10, as a depressed economy made more Americans eligible for the program, the longer-term reality is that Medicaid is significantly better at controlling costs than the rest of our health care system.

How much better? According to the best available estimates, the average cost of health care for adult Medicaid recipients is about 20 percent less than it would be if they had private insurance. The gap for children is even larger.

U.S. to Sponsor Health Insurance Plans Nationwide – NYTimes.com

The Obama administration will soon take on a new role as the sponsor of at least two nationwide health insurance plans to be operated under contract with the federal government and offered to consumers in every state.

These multistate plans were included in President Obama’s health care law as a substitute for a pure government-run health insurance program — the public option sought by many liberal Democrats and reviled by Republicans. Supporters of the national plans say they will increase competition in state health insurance markets, many of which are dominated by a handful of companies.

The national plans will compete directly with other private insurers and may have some significant advantages, including a federal seal of approval. Premiums and benefits for the multistate insurance plans will be negotiated by the United States Office of Personnel Management, the agency that arranges health benefits for federal employees.

Walton J. Francis, the author of a consumer guide to health plans for federal employees, said the personnel agency had been “extraordinarily successful” in managing that program, which has more than 200 health plans, including about 20 offered nationwide. The personnel agency has earned high marks for its ability to secure good terms for federal workers through negotiation rather than heavy-handed regulation of insurers.

Partisanship guides American attitudes on health-care reform – DC Breaking Local News Weather Sports FOX 5 WTTG

Partisanship guides American attitudes on health-care reform

Predictably, individual views on the law’s effects — for good or ill — also fell along party lines. Twenty-two percent of Democrats say the ACA has had an overall positive effect on their lives, compared to only 4 percent of Republicans. Similarly, 42 percent of Republicans deem the overall effect as negative, compared with 9 percent of Democrats.

“Republicans are much more likely to see negative effects of the ACA, including some effects (increased taxes or a decline in quality of care) which are almost certainly not linked to the Affordable Care Act,” Taylor said. “Democrats tend to see positive effects that [also] may be real or imagined.”

Although the poll numbers appear mixed, Ron Pollack, executive director of Families USA in Washington, D.C., believes that public attitudes will lean more toward the positive as 2014 approaches and more of the law’s key elements are enacted.

The Best of CBPP Graphs: Guideposts on the Road Back to Factville | Jared Bernstein | On the Economy

A nice collection of graphics, including this great one, from CBPP courtesy of Jared Bernstein…

Obamacare Is Not Causing Small Businesses To Drop Their Employees’ Coverage | ThinkProgress

And a new study assuages similar fears that small business owners might drop coverage for their employees before Obamacare takes effect in order to avoid being hit with crippling expenses. The Midwest Business Group on Health surveyed businesses across 16 states, ranging in size from small companies with fewer than 1,000 employees to larger corporations that employ more than 5,000, and found “little indication that employers plan to drop health care coverage.”

As Forbes reports, while employers understand that they may want to adjust the scope of their health benefits plans, they are not anticipating the need to drop coverage for their employees because of the health reform law’s implementation…

Orthopedic Group in Philly lays down big bet for Romney

PhillyDeals: Small-business owners plan to delay hiring process until after election

Rothman for Romney

Doctors who staff the Philadelphia-based Rothman Institute chain of orthopedic clinics were, as a group, the “top contributors to Mitt Romney’s Republican campaign for the third quarter of 2012,” the Washington Post reports, citing Federal Election Commission data.

Contributions to a pro-Romney fund from 65 Rothman doctors on Sept. 17 totaled $751,000. The second-largest Romney-donor employer group for that period worked for private-equity investors Kohlberg Kravis Roberts, which gave $480,000.

Why do these bone men want to dump President Obama? Rothman spokesman Richard Cushman declined to comment when my colleague Harold Brubaker asked.

I know, I know! They have huge incomes and don’t want them to change one little bit.

Settlement Eases Rules for Some Medicare Patients – NYTimes.com

This is pretty huge, actually!

In a proposed settlement of a nationwide class-action lawsuit, the administration has agreed to scrap a decades-old practice that required many beneficiaries to show a likelihood of medical or functional improvement before Medicare would pay for skilled nursing and therapy services.

Under the agreement, which amounts to a significant change in Medicare coverage rules, Medicare will pay for such services if they are needed to “maintain the patient’s current condition or prevent or slow further deterioration,” regardless of whether the patient’s condition is expected to improve.

Federal officials agreed to rewrite the Medicare manual to make clear that Medicare coverage of nursing and therapy services “does not turn on the presence or absence of an individual’s potential for improvement,” but is based on the beneficiary’s need for skilled care.

Disparity in pay divides doctors – The Washington Post

A nice summary of pay disparity in medicine.

Recently, a medical student confided in me a thought that few in our profession would dare say aloud: “We may have come to medical school to help people, but we choose our specialty careers based on potential salaries.”

This in part explains why the most-prized residencies are in fields such as dermatology and radiology, whose procedures generate high fees. According to a physician survey by the Medical Group Management Association, the median income of specialists is nearly twice that of primary-care physicians — $384,000 vs. $212,000. The highest-paid gastroenterologists make about $846,000 a year; the highest-paid internists make about $352,000.

As in most professions, it has long been true in medicine that specialists earn more than generalists. They train longer and in many cases pay higher insurance rates, but these factors don’t fully explain the chasm. We’ve now reached a critical point where the income disparity is harming the general population.