Tag Archives: Medicaid

If There is a Hell….

Yesterday, I wondered just how venal and despicable our politicians and plutocrats will be allowed to get  before they trigger an inevitable revolt.

Rick Scott, the obscenely rich and demonstrably corrupt Governor of Florida, is evidently trying to push those limits.

The Miami Herald obtained thousands of pages of health department documents under the state’s public records law, including nearly 800 emails and hundreds of memos and reports that detailed the state’s plan to “restructure” CMS. They show that the elimination of children from CMS was the result of a plan to slash spending on sick kids at a time when Florida had a $635.4 million surplus. For the legislative session that begins next month, Gov. Rick Scott has proposed $1 billion in new tax cuts. The spending plan would eliminate an additional 718 health department positions. […]

The parents of one Palm Beach County infant learned on the eve of a critical craniofacial surgery that their 6-month-old son had been “screened out” of CMS. The little boy is profoundly disabled, records show, having been born deaf, without eyes, and with a disfiguring cleft palate. The child’s mother called CMS in preparation for the surgery, only to be told “the screening is showing ‘NO,’ so they would not do anything.”

A post at DailyKos explained the program and summed up the situation:

This program—for Medicaid-qualified children and for those whose parents make too much for Medicaid coverage but not enough for private insurance—provides more intervention with specialists and care devised for kids with special medical needs. Some of the activities of the CMS, like “providing care coordinators to help parents access therapy and medication, and organizing one-stop clinics for kids with sickle cell disease, HIV or cleft palates,” just doesn’t happen with Medicaid.

But there was too much need in the state for the program. It was getting too many enrollees and it became too expensive to treat these kids, so the state had some options. Not having $1 billion in new tax cuts was not among the options. Dropping 9,000 kids was what they settled on.

Rick Scott’s priorities. Excuse me while I take a long shower….

Dollars and Sense

This morning, I was scheduled to participate in a statehouse rally intended to urge the Governor and General Assembly to exhibit rational behavior, also known as Medicaid expansion under the Affordable Care Act. (Of course, this is Indiana, where rational political behavior can be pretty rare.)

The weather required organizers to reschedule, but I’m posting my prepared remarks, which centered on dollars and sense.


Many of us have just wished our friends and loved ones a healthy, happy and prosperous New Year. In Indiana, those are going to be elusive goals.

According to a report issued in December by the respected Kaiser Family Foundation, Indiana stands to forego17.3 billion dollars between 2013 and 2022 because we are refusing to follow the lead of surrounding states (including those governed by Republicans) and implementing the ACA’s Medicaid expansion.

Indiana is refusing to accept the federal dollars that would pay for expansion of Medicaid despite the fact that over half a million Hoosiers have lost employer-sponsored coverage since 2000, and despite the fact that Indiana has seen the nation’s largest loss of health insurance coverage for children. More than eighteen percent of Indiana children have lost coverage since 2000.

Let’s talk dollars and sense.

Under the ACA, the federal government will pay 100% of the costs of expanded Medicaid for the first three years and 90% thereafter. Expansion would actually save Hoosier taxpayers money, since some of those federal dollars would pay for services we currently provide.

Since there is no rational reason to forego billions of dollars and deny a quarter of a million Hoosiers access to affordable coverage, some Indiana officeholders have resorted to deliberately misleading their constituents. One legislator recently sent out a survey seeking “input on legislative topics”.  The Medicaid question read as follows:

 “Currently, one out of six Indiana residents is on Medicaid, or about 1.1 million Hoosiers. Medicaid makes up about 14 percent of the state’s budget. Under the Affordable Care Act (or Obamacare), Indiana can expand Medicaid to cover more uninsured Hoosiers at a projected cost to taxpayers of more than $1.4 billion by 2020. This expansion would allow one in four Indiana residents to enroll in the program. Do you support full Medicaid expansion for Indiana under Obamacare guidelines?”

The question clearly–and dishonestly–implies that Indiana taxpayers would foot the bill for expansion. (Of course, he might get an answer he doesn’t want if he explained that new federal dollars would cover the costs.)

The question we need to ask our Senators and Representatives is pretty simple: Why are you refusing to allow the federal government to pay the entire cost of expanded coverage for three years and 90% thereafter—especially when those dollars you are rejecting would create an estimated 30,000 Hoosier jobs and, according to health economists, would reduce premiums paid by those of us who do have private insurance?

The only response I’ve heard is weak and highly speculative: the federal government might stop paying the full 90% at some future time. But if the feds cut payments, we could cut services, so that excuse just doesn’t pass the smell test.

It’s hard to escape the conclusion that Indiana is leaving 17 billion dollars on the table, leaving more of our citizens uninsured, costing Hoosiers who are insured more money, and refusing to cover Indiana’s most vulnerable children simply because our governor and state legislative leaders will oppose anything and everything proposed by this President, no matter how that opposition affects the citizens they were elected to serve.

Here’s a news flash: you don’t have to like this President—and you don’t have to like the Affordable Care Act—in order to accept billions of federal dollars that will save lives and money and create jobs for the people of Indiana.

Thanks to Governor Pence’s refusal to implement  Medicaid expansion, Hoosiers will pay higher state taxes, higher health insurance premiums and higher out-of-pocket expenses. And those costs will fall most heavily on those who can least afford them.

Our politicians may be aiming at President Obama, but the people they are hurting are the Hoosiers who elected them.


Our Own Desert Island

Later today–between I:00 and 2:00 pm– there will be a rally at the Indiana Statehouse on behalf of the nearly 400,000 Hoosiers who find themselves marooned on Indiana–the island of the uninsured.

States surrounding us, Republican and Democrat, have opted to take advantage of the new federal incentives and expand Medicaid. Not Indiana. Our Governor has decided that political posturing trumps the health needs of Indiana citizens who work in retail, education, home health, child care and other low-wage jobs without benefits. These are the people who are caught in the middle, who are too poor to use the new exchanges but  too “rich” to qualify for Indiana’s existing medical programs.

It’s pretty obvious that refusing to expand Medicaid effectively screws over these  400,000 Hoosiers. What is less obvious–and even more maddening–is how that refusal screws over the rest of us.

  • If a state expands its Medicaid coverage, the federal government will pay 100% of the costs for the first three years and 90% thereafter. Indiana is forgoing approximately twenty-six billion dollars between now and 2020–dollars that would create an estimated 30,000 sorely needed new jobs in our state.
  • The American Academy of Actuaries says that private insurance costs will rise in non-expansion states like Indiana. Local media has reported that Hoosiers are already seeing rates higher than the rates in states that surround our “island.”
  • The federal money we are turning down would offset expenses for indigent care and prison health care that are currently being covered by Indiana taxpayers.

Medicaid expansion would save money while saving lives and improving the health of our citizens. It would provide access to preventative care to those who are currently uninsured, reducing the tab for healthcare costs overall, including those that we taxpayers are now paying.

I know you’ll all be shocked to discover that Indiana currently ranks near the bottom of all states for most health indicators. In a sane world, we would jump at the opportunity to improve Indiana’s health and its economy.

Governor Pence’s refusal to expand Medicaid has already forced significant layoffs by Indiana hospitals, which have argued forcefully–but thus far unsuccessfully–for expansion. Other states with Republican governors have done the math and decided that the good of their citizens should trump their hatred of the President.

This should be a no-brainer.

I’ll forego the obvious pun.


When Elected Officials Don’t Get It, We All Pay the Price

Indiana Governor Mike Pence is adamantly opposed to the expansion of Medicaid in Indiana, despite the fact that his opposition will cost Hoosiers a lot of money–not to mention lives.

I have previously explained why our stubborn refusal to participate in this particular aspect of the Affordable Care Act is irresponsible, inhumane and costly.

When Pence announced his negotiated one-year “deal” with the federal government to continue “Healthy Indiana” in lieu of expanding Medicare (a “deal” that leaves some 400,000 Hoosiers without healthcare), he insisted that “Consumer driven healthcare is the path to the future.”

Sorry, Mike–but if that’s the case,  the future is pretty damn bleak.

Here’s the problem: markets work incredibly well when buyers and sellers operate on a level playing field. They work especially well when consumers are looking for widely-available goods and services, and can compare prices and quality and shop around for the best deal. Economists define a market transaction as one involving a willing buyer and willing seller, both of whom are in possession of all relevant information.

That description does not remotely apply to medical care.

The “consumer” who needs a hernia operation is highly unlikely to be in a position to shop around. He’s much more likely to need immediate care, and be locked into using a particular provider by his insurance company. And he is highly unlikely to know as much about the procedure as his doctor.

For that matter, this “consumer transaction” isn’t going to be negotiated by the patient and his doctor. The real parties to this transaction are the doctor and the health insurance company–and as recent news reports have reminded us, the needs of the patient are rarely front and center. (The Star recently reported on a lawsuit brought by the widow of a man who needed a pacemaker–despite the urging of his own doctor and another doctor who was consulted for a required “second opinion,” the insurer delayed its approval, and the man died. The doctor insists that, had his patient had a timely procedure, he’d be alive today.)

There is no market in health care. There never will be. Hernias and heart attacks aren’t widgets and mousetraps; there is not and cannot be a level playing field where consumers have as much information and power as their providers–or where their providers have as much power as the insurers. Other countries have figured that out. And in those other countries, amazing as it may seem, big bad evil government has turned out to be more protective of patient needs than for-profit insurance companies beholden to their shareholders.

To suggest that “consumer-driven” healthcare is the future is to display profound ignorance of market economics.

I think it’s interesting how many “free market” ideologues like our governor have no idea how markets really work.



Unhealthy Indiana

Yesterday, the IBJ reported the latest data on public health indicators, under a headline that telegraphed the results: “Indiana public health continues to slide.”

When the most recent data is compared to previous studies, it becomes quite clear that Hoosiers are moving in the wrong direction. We are fatter, more sedentary, more diabetic. Hoosiers smoke more than citizens elsewhere, and more of our babies die in infancy.

Not exactly a distinction we would choose.

Furthermore, since our policymakers seem to care a lot more about money than about Hoosier health and well-being, it may be useful to point out that poor health drives up costs. As the IBJ pointed out, Indiana employers spend more per worker on healthcare than employers elsewhere in the country. And that doesn’t include the costs of sick days or reduced productivity as a consequence of health issues. (Forgive me for an indelicate observation: Indiana legislators determined to keep business taxes low don’t seem to understand that the added costs incurred by reason of an unhealthy workforce are just as much a part of business overhead as state income or property taxes.)

No–true to our Hoosier Heritage, which is nothing if not shortsighted–State government is perfectly content to shift health costs to employers, and keep Indiana’s public health spending low. And it is low. In 2012, Indiana ranked 49th out of 50 states in per person spending on public health, despite the fact that preventative public health measures like immunization and screenings demonstrably and dramatically lower overall health costs.

To add insult to injury, Governor Pence has signaled that he will not expand Medicaid in order to participate in the Affordable Care Act, aka “Obamacare.” As I have previously noted, there is no rational basis for that decision; it rests entirely upon a perceived political need to pander to a rabid GOP base motivated solely by an unreasoning hatred of President Obama and anything he supports.

If Indiana opts to participate, an estimated 450,000 Hoosiers would benefit. And here’s the kicker: if Indiana does participate, the federal government will pay all the costs for the first three years. The state’s portion would then phase in gradually, topping out  at 10% in 2020.

And if we don’t participate? Well, poor people have this pesky habit of getting sick anyway. And we already pay to treat them–frequently, in the least cost-effective way, when they appear at hospital emergency rooms. When uninsured folks are treated there, the costs of their un-reimbursed care drives up the premiums of those with insurance. If the hospital is public, our taxes go up. If the hospitals still can’t recover their costs, they cut healthcare workers or reduce services. The 10% Indiana would eventually have to pay to cover far more people is unlikely to be more than we are actually paying now in a variety of ways–it would just be more visible and much more cost-effective.

Indiana certainly wouldn’t want to do something that was actually cost-effective.