Tag Archives: Medicaid

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.

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An Unhealthy Partisanship

As Hoosiers proved again last November, we’re a Red, Red State. And evidently, that partisan identity–and a deep desire to thwart that Kenyan interloper who inexplicably occupies the White House–is motivating a costly and immoral decision on healthcare.

The Affordable Care Act–aka “Obamacare”–provides incentives for states to expand Medicaid coverage. That expansion is not mandatory, however. (The Supreme Court’s decision upheld the Act, but not provisions making Medicaid expansion obligatory.)

There’s a lot of misunderstanding about Medicaid and who it covers. Currently, Indiana’s Medicaid program provides health care to about one in seven Hoosiers–mostly children, pregnant women, the disabled, seniors in long-term care and very low income families. The word “families” is key here, because non-disabled childless adults under the age of 65 are not eligible for Medicaid, no matter how poor they are. And the “eligibility” of families with children is mostly illusory: a family of three (mother, father, child) with income over $4582 a year makes too much to qualify.

The new health reform law gives Indiana the option of expanding Medicaid to provide care to Hoosiers who are currently uninsured–by increasing eligibility to low-income working adults with incomes up to 138% of the federal poverty level. Last year, that would have been $15,415 for an adult, and would have allowed that  family of three to make the princely sum of $26,344.

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.

The arguments against participating mainly boil down to two: the feds might change the formula sometime in the future, and we don’t like the government or the President.

Let’s see: on the one hand, the federal government will pay to cover nearly half a million Hoosiers whose lack of insurance is currently costing all of us money and jobs. On the other hand, we can show that socialist Barack Obama how much we hate him.

Even Ohio Governor John Kasich–a man without a “blue” bone in his body–has concluded that cutting off one’s nose to spite one’s face is rarely a sane public policy option.

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Fun With Numbers

The Affordable Care Act  maintained existing Medicaid coverage for low income children. Whether or not their parents will have coverage is being left up to the states.
In Indiana, that’s a problem.
As a recent report from the Institute for Working Families explains, right now, Indiana only covers working parents who make up to 24 percent of the poverty line, which comes to $4,581 a year for a family of three. The Medicaid expansion provision in the Act encourages coverage for these low income adults by expanding Medicaid to 133 percent of the poverty line ($25,390 for a family of three).  According to a recent study by the non-partisan Kaiser Commission on Medicaid and the Uninsured–a study which is consistent with Congressional Budget Office’s estimates– 215,803 previously uninsured Hoosiers would have access to care by 2019–if Indiana implements that provision of the Act.
And why wouldn’t we?  The Act provides 100 percent federal funding for the expansion of Medicaid for its first three years, phasing down after that to 90 percent federal funding by 2019.  According to the same study by Kaiser, this will cost Indiana $478 million from 2014-2019 (an average of $79 million each fiscal year).
Interestingly, in a study commissioned by the State of Indiana, the estimated cost (2.58 billion) is approximately 5 times greater than the cost shown by the non-partisan Kaiser study (478 million).
What the Indiana study evidently ignores are the savings involved: Medicaid expansion would save the state substantial amounts we now pay for uncompensated care for the uninsured. We pay those costs two ways: through our tax dollars, and through higher premiums charged to those who are insured. (In fact, according to Kaiser, during the 2014-2020 time period, each insured Hoosier will otherwise pay over $2000 to subsidize the uninsured.)
Let’s try an analogy: let’s say you’ve been taking a bus to work, and you and a couple of friends buy a car. Your share of the car expenses will be 150. a month. The cost to you will thus be 150 per month minus the 40 bucks a month you’ve been spending on the bus. This is a concept called net cost. 
If the state refuses to expand Medicaid, people with incomes between 100 percent and 400 percent of the poverty line will be eligible for subsidies to help them afford coverage in the new health insurance exchanges.  But people below the poverty line won’t receive coverage at all, since the Affordable Care Act assumes they’re covered by Medicaid.
That seems deeply unfair–even immoral.
My question is: why is depriving these people of coverage so important a goal that the Daniels Administration is willing to issue a deceptive analysis of the costs involved?
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For Once, a Good Day

Yesterday was a trifecta for those of us who live in Indiana and care about public policy.

Two separate federal judges enjoined major parts of two of the most shameful acts passed by the most recent Indiana General Assembly–the immigration bill and the anti-abortion bill. (The latter not only defunded Planned Parenthood, but also required doctors to give women medically inaccurate information. Both provisions were enjoined.) The ideologues who “serve” in the Indiana legislature had been repeatedly advised that both measures had serious constitutional infirmities, but hey–why let a little thing like the constitution get in the way of serious pandering and outright nuttiness?

If the issuance of those injunctions wasn’t satisfying enough, late last night New York State passed a bill authorizing same-sex marriage, and Governor Cuomo came to the floor to sign it.

There was a lot to relish about that victory for fundamental fairness and basic civil rights.

The New York legislature is controlled by Republicans, but the majority party did not block the vote, and four Republican votes provided the margin of victory. The Governor was one of the bill’s strongest supporters. Michael Bloomberg, Mayor of New York City, hailed the bill’s passage. And New York’s authorization doubled the number of Americans who now live in a state where same-sex marriage is legal.

A few minutes after the bill passed the New York Senate, the Empire State Building “went Rainbow”–the building was bathed in rainbow lights that had been purchased for the city’s Pride Parade that, in a happy coincidence, was scheduled for today.

Granted, yesterday was only one day, but it was a welcome recess from the pettiness, stupidity, anti-intellectualism and bigotry that have characterized our civic and political life for far too long. I don’t know about you, but I plan to savor it.

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Robin Hood, Willly Sutton and Tax Policy

Back in the 1950s, there was a concerted effort to keep schoolchildren from reading “Robin Hood,” because the story exalted a communist–Robin Hood, after all, took from the rich to give to the poor. (We are not the only generation to live with widespread paranoia.)

The notion that taxes are robbery has a long and inglorious history in this country. Rather than thinking about taxes as the dues we pay for civilization, taxes have been framed as extortion. Progressive taxation, especially, is characterized (in Ayn Rand fashion) as robbing the deserving, productive rich to feed the unproductive mobs of poor. This myth has endured despite the fact that there is no empirical evidence supporting the notion that lower taxes on the rich spur job creation, and in the face of the truly obscene paychecks going to the “titans of finance” whose credit default swaps and other financial chicanery produced nothing of value and threw the country into recession.

This morning, we awoke to see that the Congressional Republicans are proposing dramatic cuts to Medicare and Medicaid. As my husband observed, the GOP evidently has no problem taxing the poor. He’s right–taking medical care from the elderly, poor and disabled is simply a tax of another name.

The proponents of this “reverse Robin Hood” taxation are both heartless and stupid. They are heartless because they are attacking the most vulnerable in order to protect the pocketbooks of the most affluent, who are currently paying the lowest percentage of their incomes in taxes in more than 50 years. They are stupid because there is no way to balance the budget on the backs of those who have little or nothing.

When Willie Sutton was asked why he robbed banks, he replied “Because that’s where the money is.” Any genuine effort to reduce the deficit would take a lesson from Willie.

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