Medicaid – The Moral Healthcare Blog

Fertile ground for Medicaid pitch- The Washington Post

Remote Area Medical back in western Virginia, as the battle to expand Medicaid rolls on…

The three-day clinic, which relies on more than 1,000 volunteers, will serve as many as 3,000 people before it ends Sunday. The vast majority of patients — more than 70 percent — come for dental care, Brock said.

Every year, hundreds of people have every one of their teeth pulled there. Then they put their names into a denture lottery, with the hope of being picked to get a set of false teeth made for them at the next year’s event. Forty-six people were picked from a list of 700 to get dentures this year.

“They pull thousands of teeth here. At the end, they’ll have buckets of teeth,” said volunteer Jennifer Lee, Virginia’s deputy secretary of health and human resources and an emergency room doctor.

Medicaid expansion would not fully alleviate the dental situation. Medicaid does not cover routine dental care for adults or dentures. But Medicaid does pay for emergency tooth extractions, so patients would not have to wait a year to have a bad one pulled.

“I just had an 18-year-old have a full mouth extraction because she’s never had dental care,” said Beth Bortz, who runs the Virginia Center for Health Innovation. “It’s not unusual.”

She said patients often want their good teeth removed, too, because they associate teeth with pain. She said health-care providers counsel them to keep them.

– The Washington Post

Hospitals wounded by politics – Opinion – The Times-Tribune

Scranton’s three hospitals are among more than one-third of hospitals statewide that lost money in 2013. More than half of the state’s hospitals had profit margins lower than 4 percent for the year, the threshold for sustainability according to the Pennsylvania Health Care Cost Containment Council.

It’s a trend that likely will continue statewide through 2014 and beyond unless the Corbett administration abandons its politically inspired resistance to the Affordable Care Act’s expansion of Medicaid.

The losses have multiple causes, but one key driver is the rising cost of uncompensated care — treatment for patients who have no private or public insurance and cannot pay.

According to the council, known as PHC4, Pennsylvania hospitals provided more than $1 billion in uncompensated care in 2013, a 5 percent increase over 2012.

Gov. Tom Corbett foolishly has rejected a portion of the federal health care law which, in other states that have accepted it, has begun to diminish levels of uncompensated care and provide hospitals with much-needed revenue.

Under the ACA, the federal government pays 100 percent of the cost of Medicaid expansion to cover uninsured low-income workers in the first two years and covers 90 percent of the cost thereafter.

It’s an extraordinary deal for states. In Pennsylvania, it would have pumped about $17 billion into the health care economy through 2019, including about a $1.6 billion direct reduction in the amount of uncompensated care. That reduction likely would be higher because many people now receiving treatment at hospitals would have insurance enabling them to see other providers first.

Hospitals wounded by politics – Opinion – The Times-Tribune

Paper: Gov. Tom Corbett health plan would need 700 workers

HARRISBURG (AP) — Gov. Tom Corbett’s Healthy PA, an alternative to expanding Medicaid, will require the state to hire more than 700 new employees, a newspaper reported Monday.

The figure was far higher than most states have experienced and came as a surprise to some experts in public policy, The Philadelphia Inquirer said.

Most of the new hires would be caseworkers in offices scattered around the state, said Bev Mackereth, Corbett’s public welfare secretary. She said that under Pennsylvania’s system, the caseworkers do more than in some other states, including evaluating those who sign up for potential eligibility for other benefits as well.

She said in an interview Monday that Pennsylvania also trails some other states in automation, which adds to the cost.

“We’re getting there, and we’re not where other states are,” she said. “Some states have everything automated — it’s very easy for them to do.”

The newspaper said the state has estimated about 605,000 people would be newly eligible under Healthy PA. The first-year cost of the 700-plus new hires will be just over $30 million, much of it subsidized by the federal government.

Mackereth said the additional personnel costs would be more than covered by the estimated Healthy PA savings of $125 million.

The Department of Public Welfare estimates it would require even more new workers — about 1,200 of them — to expand Medicaid under the President Barack Obama’s landmark health care law.

Corbett, a Republican seeking a second term this year, is waiting to hear back from federal regulators about Healthy PA. It would use Medicaid expansion money to provide private insurance coverage for the same group of people. Those private insurers would be able to operate without some of Medicaid’s coverage rules.

Paper: Gov. Tom Corbett health plan would need 700 workers

Pennsylvania isn’t serious about expanding Medicaid. How do we know? – latimes.com

Pennsylvania Gov. Tom Corbett has lately been getting credit in the political press for being one of those Republican governors coming around on the expansion of Medicaid under the Affordable Care Act. Advocates for the underprivileged can’t understand why.

They’re right to wonder. Corbett’s "Healthy Pennsylvania" plan, which was released for public comment this week, is a sham. It would reduce health benefits for many of his neediest citizens and impose punitive conditions on their coverage. It requires waiver approval from the federal government that’s almost certain to be refused, because some of its provisions are in flagrant violation of federal law. And even if it were approved, Corbett waited so long to put his plan together that it probably couldn’t be implemented until 2015. In the meantime, 500,000 of his citizens will be medically uncovered.

"He’s being very disingenuous," says Joan Alker, executive director of the Center for Children and Families at Georgetown University. "He knows a lot of this proposal is not approvable" under federal law.

Corbett’s proposal shows that many Republicans still aren’t done posturing with their citizens’ lives, even as some have done the right thing–among them Gov. John Kasich of Ohio and Jan Brewer of Arizona. Some GOP governors, like Rick Perry of Texas and Bobby Jindal of Louisiana, seem determined to take their neediest citizens all the way down–they’re not budging on their refusal to expand Medicaid coverage.

Corbett wants to have it both ways. He intends to masquerade as a feeling governor intent on bringing healthcare to the masses at practical cost. But beneath the fancy dress lies a cynical politician who knows his plan isn’t practical. If it gets rejected he’ll blame the Obama administration. "We tried," he’ll say. "But they blocked us." Don’t be taken in.

Pennsylvania isn’t serious about expanding Medicaid. How do we know? – latimes.com

I Watched My Patients Die of Treatable Diseases Because They Were Poor | Alternet

There’s a popular myth that the uninsured—in Texas, that’s 25 percent of us—can always get medical care through emergency rooms. Ted Cruz has argued that it is “much cheaper to provide emergency care than it is to expand Medicaid,” and Rick Perry has claimed that Texans prefer the ER system. The myth is based on a 1986 federal law called the Emergency Medical Treatment and Labor Act (EMTALA), which states that hospitals with emergency rooms have to accept and stabilize patients who are in labor or who have an acute medical condition that threatens life or limb. That word “stabilize” is key: Hospital ERs don’t have to treat you. They just have to patch you up to the point where you’re not actively dying. Also, hospitals charge for ER care, and usually send patients to collections when they cannot pay.

My patient went to the ER, but didn’t get treatment. Although he was obviously sick, it wasn’t an emergency that threatened life or limb. He came back to St. Vincent’s, where I went through my routine: conversation, vital signs, physical exam. We laughed a lot, even though we both knew it was a bad situation.

One night, a friend called to say that my patient was in the hospital. He’d finally gotten so anemic that he couldn’t catch his breath, and the University of Texas Medical Branch (UTMB), where I am a student, took him in. My friend emailed me the results of his CT scans: There was cancer in his kidney, his liver and his lungs. It must have been spreading over the weeks that he’d been coming into St. Vincent’s.

I went to visit him that night. “There’s my doctor!” he called out when he saw me. I sat next to him, and he explained that he was waiting to call his sister until they told him whether or not the cancer was “bad.”

“It might be one of those real treatable kinds of cancers,” he said. I nodded uncomfortably. We talked for a while, and when I left he said, “Well now you know where I am, so you can come visit me.”

I never came back. I was too ashamed, and too early in my training to even recognize why I felt that way. After all, I had done everything I could—what did I have to feel ashamed of?

UTMB sent him to hospice, and he died at home a few months later. I read his obituary in the Galveston County Daily News.

I Watched My Patients Die of Treatable Diseases Because They Were Poor | Alternet

Obamacare meets extra resistance in Oklahoma – Page 2 – Los Angeles Times

The cognitive dissonance should make these people’s heads explode, but I don’t think there’s enough cognition to create the dissonance.

In dozens of interviews here, many said they feared they would be forced to buy insurance they couldn’t afford. Some said they were told (erroneously) that insurance penalties would come out of their Social Security checks; others said they’d heard the law meant they’d soon have to travel several hundred miles to see a doctor.

"They say it’s affordable, but when you ain’t got no money, nothing’s affordable," said 55-year-old Paul Bush of Midwest City, who accompanied his sister to a clinic for care last week. While he supports efforts in Congress to kill the program — "Heck yeah," he said — he wasn’t happy about Fallin’s decision to reject the Medicaid expansion: "The state could really have used the money."

Bush’s sister, Teresa Springer, might have qualified for care under a Medicaid expansion, but she supported Fallin’s decision.

Springer, who has applied for disability assistance, said she worried that fines related to the healthcare law would cut into her disability checks at the same time that some Republicans in Congress were talking about cutting food stamps.

"That’s all I have," she said after a visit to the Mary Mahoney Memorial Health Center in Spencer, Okla. "I’m going to either pay my bills or not eat." The law, she added, "is hurting everybody."

Obamacare meets extra resistance in Oklahoma – Page 2 – Los Angeles Times

Uninsured in Pennsylvania reaches record high – Pittsburgh Post-Gazette

Overall the number of uninsured Pennsylvanians increased by 11 percent from 2011 to 2012, while nationally the number decreased by 1.4 percent.

The numbers, based on data from the U.S. Census Bureau and the Centers for Medicare and Medicaid Services, reflect a troubling trend in health care insurance, which people traditionally received through their employer.

"We continue to see a dangerous erosion of employer-based coverage," said Andy Carter, president and CEO of the Hospital and Healthsystem Association that represents the interests of nearly 240 health facilities.

"The number of Pennsylvanians covered by private, employer-based plans hit an all-time low of 59.5 percent in 2012," he said.

And that’s not solely because people are out of work, he added.

"Three out of every 4 uninsured Pennsylvanians live in a household with at least one working adult, and nearly 4 out of 5 live in Pennsylvania’s suburban and rural regions," Mr. Carter said.

The association has advocated for the expansion of Medicaid as outlined under the Patient Protection and Affordable Care Act.

Uninsured in Pennsylvania reaches record high – Pittsburgh Post-Gazette

APPRISE: Older Adult Health Insurance Counseling, Allegheny County, Pennsylvania

Older Adult Health Insurance Counseling

APPRISE

APPRISE 412-661-1438 or APPRISE@fswp.org.
APPRISE offices are open Monday through Friday from 9:00 a.m. to 4:00 p.m.
SeniorLine 412-350-5460, toll-free 1-800-344-4319, TTY 412-350-2727 or SeniorLine@alleghenycounty.us
APPRISE is a free health insurance counseling program designed to help Pennsylvanians, age 60 years and older. APPRISE volunteer counselors are specially trained to answer consumer questions and offer education about Medicare, HMOs, long-term care insurance, supplemental insurance, and Medicaid benefits. APPRISE services are free, objective and completely confidential.
APPRISE counselors are available to assist an individual in the following ways:

Determine if a Medicare HMO is right for the individual by explaining the way Medicare HMOs work.

Understand Medicare benefits by explaining what services are covered under Medicare Parts A and B and the Medicare Summary Notice.

Select a Medigap insurance policy by explaining the benefits in each plan and providing a list of companies that sell these plans.

Obtain assistance to pay for prescription drugs through government and private programs that offer this service, and explain the eligibility requirements and how to apply.

Find government programs that will pay Medicare deductibles, co-payments, and Part B premiums and assist consumers with the paperwork.

Understand long-term care by explaining eligibility requirements for government long-term care programs and explaining private long-term care insurance and how to select the best policy.

APPRISE services are free and all information is kept completely confidential. To contact a counselor, contact the APPRISE coordinator at 412-661-1438 or APPRISE@fswp.org. For general information on this and other services for older adults, you may contact the DHS AAA SeniorLine at 412-350-5460, toll-free 1-800-344-4319, TTY 412-350-2727 or SeniorLine@alleghenycounty.us.
Pennsylvania Health Law Project (PHLP)
PHLP 1-800-274-3258 works to overcome barriers to accessing health care coverage and services. They provide:

Health Insurance Coverage, Department of Human Services, Allegheny County

Michigan’s Approach to Medicaid Expansion and Reform — NEJM

Five core principles are evident in Michigan’s approach to expanding and reforming Medicaid under the ACA. First, the state must achieve sufficient savings to offset its contributions for the Medicaid expansion when federal funding drops from 100% to 95% in 2017 and to 90% in 2021. Medicaid coverage of some state-financed health services, including mental health and prison health programs, is expected to result in approximately $200 million in savings for the state budget in 2014. If the state’s costs are not offset by such savings, Michigan will withdraw from the Medicaid expansion in 2017 or later years. But current projections indicate that the state’s cumulative savings should cover the additional costs through 2027.5

Second, Michigan will introduce financial incentives for new Medicaid enrollees to control their use of health care services and to maintain healthy behaviors. For 150,000 new enrollees with incomes between 100% and 133% of the federal poverty level, cost sharing amounting to as much as 5% of their annual income (approximately $580 to $775 for a single adult) is slated to begin 6 months after Medicaid enrollment. After 48 months of Medicaid coverage, cost sharing for these new enrollees will increase to 7% of their annual income, or they can choose to enroll in subsidized private insurance offered through the state’s health insurance exchange. A system resembling health savings accounts will be created for individuals or their employers to deposit funds to cover copayments for health care services. Cost sharing can be reduced to 2% of annual income for new enrollees who demonstrate that they engage in healthy behaviors.

Third, the state will enroll newly eligible adults in private health plans rather than in traditional fee-for-service Medicaid. Health plans will be eligible for financial bonuses for effectively managing enrollee cost sharing required by the state and for achieving cost and quality targets. Health plans will also be directed to implement value-based insurance design by varying cost sharing according to the clinical value of services provided.

Fourth, Michigan’s new law addresses health care delivery by requiring that new enrollees have access to primary care and preventive services. New enrollees will also be offered the opportunity to complete advance directives for end-of-life care when they enroll in Medicaid — part of a broader state initiative to encourage residents to express their preferences regarding end-of-life care.

Fifth, Michigan’s new Medicaid law enhances the state’s capacity to monitor the costs and quality of health care. The Department of Community Health, which oversees the Medicaid program, will assess opportunities for improving the Medicaid program and make Medicaid data available to outside vendors that can help participating health plans to pursue innovations in the program. The Department of Insurance and Financial Services will evaluate the effect of the Medicaid expansion on private insurance premiums in the state; some reduction in these premiums is anticipated.3,5 A new Health Care Cost and Quality Advisory Committee will be created to promote greater transparency with respect to the costs and quality of care.

Michigan’s Approach to Medicaid Expansion and Reform — NEJM