State Budgets and Medicaid
http://thedianerehmshow.org/shows/2010-11-23/state-budgets-and-medicaid
The new health care legislation has far reaching consequences in many areas and among these is Medicaid. The law seeks to use the Medicaid system to expand overall health care coverage for those who cannot afford to pay starting in 2014. Federal funds will be available, initially, to help states with the additional costs, but many states are facing acute budget shortfalls now and are unable to provide health care services to people already on their rolls. To deal with the crisis some states are considering opting out of the Medicaid system altogether. Please join us to discuss state budgets and the future of Medicaid.
Guests
Judy Feder
senior fellow, Center for American Progress and professor of public policy at Georgetown University.
Edmund Haislmaier
senior research fellow, Heritage Foundation
Janet Adamy
reporter, Wall Street Journal
Warren Chisum
Representative, Texas State Legislature
Charles Duarte
administrator, Division of Health Care Financing and Policy
State of Nevada
Comments
Please familiarize yourself with our Code of Conduct and Terms of Use before posting your comments.
If you look at the people in the USA who are "too poor to pay" for medical help, and then you look at the desperation of North Korea you realize both nations face legitimacy problems. Both have populations in the tens of millions that are confined under limited circumstances without opportunities or resources; and both nations lash out with war violence to mobilize patriotism and hold the nation together. When a few wealthy families at the top possess everything of value under control of a sovereign nation state there is inevitable deprivation. Instead of trying to destroy humane intervention, and convening commissions to refine the maximal deprivation of the disadvantaged while enhancing the take of the advantaged, a benign nation state would seek a way of employing, educating and doctoring all those in its charge. Ideology aside; just look at the wealth and income chasm. If delivery of badly needed aid is called Medicare I am all for it. It is the so-called success of the few that costs the rest of us.
I am wondering how much of the burden on Medicaid is due to failure to provide coverage by the private health insurance market. I am self-employed and when my wife became pregnant we found there was only one insurance company that provided pregnancy coverage in our state, but we couldn't sign up because of their rules about changing our policy more than once per year. We applied and were approved for Medicaid coverage, but we would be more than happy to have purchased coverage ourselves if available. Why can't we have a system that lets those people who are able help pay into the system? I can't help but feel that Medicaid is helping to support the current business models of the private insurers who don't feel like covering all of those that Medicaid picks up.
-Jeff
Here is another economy show with no talk about corporate responsibility. There's talk about the government, and what people are doing but NEVER talk about corporations putting patriotism ahead of excess profits in these hard times. Corporations caused the problem, and they are the solution, they could stop joblessness tomorrow by not firing people anymore. Time to stop coddling corporations and talk about their fair share. When you don't talk about the main aspect of the recession then nothing you say can be trusted.
I would like to comment on the proposed cuts in Nevada. Cutting adult day care and home health attendants will create a significantly increased burden on family caregivers. Already more than 70% of all family caregivers report having to have made accomodations in their employment to take care of a loved one - including reduced hours and stopping work altogether. Mr. Duarte remarked that beneficiaries would have to rely more on family and friends - but has he calculated the cost of that? The family and friends will become unemployed, lose thier benefits and ultimately need to become beneficiaries themselves when they retire and have no retirement savings or insufficient social security contributions. Cutting these services as proposed simply delays expense tothe states and is not a solution.
The representative from Texas sounded like my daughter. She wants her allowance but doesn't want to do her chores to get it. Texas and other states have the ability to opt out of the program, and not take the Federal money. Same goes with Transportation and Education programs from the Federal Government
What about our national failure to maintain good health? There is a looming crisis (and ballooning cost) based upon the increasing poor health of our population. Diabetes, obesity, heart disease are all on the rise and are all based on lifestyle choices.
Mary
Please don't forget the Elephant In The Room:
The states and feds both struggle to make this affordable because for-profit insurance companies and hospitals and nursing homes are pushing up prices to keep giving profits to shareholders. The Public Option was a weak attempt to try to do an end run around the profit-margin. Pull up your socks and force Wall Street out of hospitals.
Take the investors out of health care and make it affordable for everyone. Perhaps the disappointed investors can turn their attention to investing in renewable resources for power, because that need isn't going away either.
Maggie in Fort Worth, Texas
Unfortunately, I did not catch his name, but the Republican representative from Texas mis-spoke when asked about the type of cooperation States needed from the federal government in regards to the Medicaid Program. If I heard and understood him correctly he suggested that States are prohibited by the Federal government from questioning Medicaid recipients about their employment status and income when determing medicaid eligibility or continuing eligibility. This is NOT true. It is the opposite, States MUST require applicants for Medicaid and those receiving Medicaid to verify employment status (working, unemployed), income amount and source for all family members, assets, cash savings, investments, EVERYTHING and the State agency also runs the social security numbers and if the information from the report of activity under the social security number/s don't match the information provided to the agency by the applicant or program participation, the application is denied and the person is subject to prosecution for fraud. Perhaps the Representative could call in and clarify his statement, by citing the federal rule or administrative rule that applies to his comment. Lacking this clarification, I don't know what the difficulty is to the States, because additionally, regardless of what the federal requirements or administrative rules are, States can apply for waivers to the rule and proposed their own rules for implementation of all programs, including Medicaid.
Thank you
Mr. Chisolm says Texas may be forced to opt out - refusing the $25 Billion from the Fed - so they can control the money. Being able to verify eligibility will save over 60% of the program costs without reducing care!? Methinks someone is being disingenuous to wrest more control of Federal funds.
And, the news entertainers on the right can parrot again and again, "Obamacare is so ruinous many states will be forced to opt out." Another ploy to keep their base agitated.
Gov. Perry comments on FOX, the Federal Government cannot afford to be involved in medical care, just send us the money, no strings attached and we'll control it. Mr. Chisolm did not answer your question: "How will that lower the Federal deficit?"
My concern is that historically, when states ran more things, the poor and the minorities fared poorly. We still have a black population whose health is more at risk because of past neglect. A real country needs a unified healthcare system that is available to all regardless of status... we would not need medicaid or medicare in a real democratic country if we had a real healthcare system for all. We need desperately to challenge these republicans and the bean counters who think that we do not need these programs. They never question wasting money on useless wars! Do they? A country needs to get past the historical bases that have brought us to the kind of debate we insist on. The rest of the world thinks us we are totally out of step in a world of human rights and civil rights we try to impose on others but refuse to implement in our own backyard.
My concern is that historically, when states ran more things, the poor and the minorities fared poorly. We still have a black population whose health is more at risk because of past neglect. A real country needs a unified healthcare system that is available to all regardless of status... we would not need medicaid or medicare in a real democratic country if we had a real healthcare system for all. We need desperately to challenge these republicans and the bean counters who think that we do not need these programs. They never question wasting money on useless wars! Do they? A country needs to get past the historical bases that have brought us to the kind of debate we insist on. The rest of the world thinks us we are totally out of step in a world of human rights and civil rights we try to impose on others but refuse to implement in our own backyard.
I would invite the DR Show to follow up on this program. What is wrong with challenging the widely held American concept that states can do things better and cheaper? What is wrong with challenging those who think that a national healthcare program does not benefit the whole country? We have never counted the damage we are still suffering from non having had a national plan ever in the history of the country! What would have happened if we had taken care of all regardless of eligibility or means... we would have been today a healthier country and would be saving... we can still do that by working now on a plan to make us healthier in a decade or even less ... by working on sensible national program that give every one living in this country access to healthcare! It's the civilized thing to do... it's the right thing to do... it's what a truly religious country should do... and it is sad to see so called Christians claim their country should not... for what... for a kind of responsibility and accountability that has nothing to do with good health... of all the countries of the world, I believe that we, with our discipline, and our potential for controlling costs, we could have a system that could be a model for the rest of the world... and copping out of a universal system of healthcare is simply a cowardly thing to do that makes us look bad abroad!
I would invite the DR Show to follow up on this program. What is wrong with challenging the widely held American concept that states can do things better and cheaper? What is wrong with challenging those who think that a national healthcare program does not benefit the whole country? We have never counted the damage we are still suffering from non having had a national plan ever in the history of the country! What would have happened if we had taken care of all regardless of eligibility or means... we would have been today a healthier country and would be saving... we can still do that by working now on a plan to make us healthier in a decade or even less ... by working on sensible national program that give every one living in this country access to healthcare! It's the civilized thing to do... it's the right thing to do... it's what a truly religious country should do... and it is sad to see so called Christians claim their country should not... for what... for a kind of responsibility and accountability that has nothing to do with good health... of all the countries of the world, I believe that we, with our discipline, and our potential for controlling costs, we could have a system that could be a model for the rest of the world... and copping out of a universal system of healthcare is simply a cowardly thing to do that makes us look bad abroad!
Interesting...so what to fund?....smart bombs or meals on wheels. When you get nonsense from the Heritage foundation and the Texas whahoos in the debate, you get failed conservative theories and myopic madness being offered as rational persuasion.
Look, we as a nation spends more on it's military than the next 15 nations COMBINED! Here is a thought: Let's reduce our national spending by HALF and see who invades. I'm sure we would be quite safe and we would free up much needed funding for a really good national healthcare program. After all, the military is really just a jobs program anyway. And please stop inviting these conservative "think tanks" on the show to represent such perilous and detrimental points of view. As a nation, we need to be taking care of the citizenry, not ignoring them only to support the corporate welfare that the capitalists have grown accustomed to.
The representative from Texas makes me laugh. Yes, they could handle it themselves, but ultimately care and coverage would be reduced, just like their private health insurance system. I moved there for a good job, but couldn't get health insurance for my family, regardless of the cost. One of the guests mentioned South Carolina as a state that also wanted to run their own Medicaid programs. Funny, that's where we tried to move to after Texas, and were also unable to purchase health insurance, regardless of the cost. As a result, another state receives taxes and benefits from our income, the purchase of our house, cars, goods and services, college education, and yes, health care premiums.
These states help limit coverage through the private health insurance system, do you really think they won't do the same with a state run program?
As a physician I see the medcaid system does help many people. I feel everyone should be covered by healthcare: a basic right ( that is the nice part)!
As a system I have observed the medcaid system is broken. For the practioner it cost money to see a patient. It is not about just not making money; if your practice depended solely on medcaid you would not be in business very long. Institutin may make money on medcaid, but the individual physician loses money. The medicaid system is broken and is a good example of why the government should stay out of health care as much as possible.
Is there any plans to fix medcaid so that physicians can actually afford to see medicaid patients?
Reply To Tom Hendricks:
It infuriates me to no end when I hear the ignorance about these big evil corporations when we have had a government that has wasted trillions of tax payer dollars over 50 years and we are still in a hole.
I happen to be a 54 yr old man just hired by one of those evil corporations with better benefits than was offered previously . Think it might be that guilt?
Putting that aside, always see how those evil corporation contribute to NPR, the Arts, and yes homeless shelters. Not only do they give financial contributions but provide the volunteers for fund raising at NPR and PBS.
Employment: A lot has changed over the last 30 yrs where technology has taken the place of people. No need for HR or secretaries when a computer replaces that unneeded position or would you prefer a government that pays people not work. I saw that during my 6 month unemployment.
Last but not least, hording all that money with cutbacks,excessive profits,etc.I too would be concern with the present administration in office. But something else, I happen to be part of the 70% of American Worker who has an IRA, 401 K retirement. I've seen higher dividends paid into my accounts. Remember S.S. is broke because of the politicians and Federal government
Jeff:
The reason that you cannot get coverage has to do with the politicians and administered by Federal bureaucracy. You only had one insurance company offer you a policy under certain stipulations . But there are thousand of insurance companies. This Health Reform Act that past last year has nothing in the way of private companies competing across state lines, no saving accounts and do not even mention tort reform.
Big Sis, Kathleen Sabelius Secretary of Health will be the judge in what or what can be done with health policy.
And it is only going to get worse. There will be no competition among these so called "Government Exchange Insurance Companies" because all rates will be set and you are going to have medical profession saying the "Hell with this". I sacrifice going to school for 12 years have overhead costs (staff, rent) and only be allowed to charge this much for treatment.
Perfect example but in another area is Medicare. Doctors are refusing to accept medicare patients because of low payments and paper work.
Forty-five percent of all doctors in Texas do not take Medicare patients.
Good luck to you and your new family.
Lisa:
Then what is your suggestion? You have 14% unemployment in Nevada. Raising taxes will certainly hurt those who are lucky enough to have a job
Maggie:
If you believe that private insurance companies are there only for the shareholder than that might not be a bad thing. 70% of today American Workers have their retirement be it in IRA, 401k and have dividends paid by some of these companies. Some of us in the middle class have not been able to retire because of the market.
Private Health Insurance Companies make around 6% as stated in article in August 2009 US News & World Report. Look it up.
You take the profit away from the health care business and you will get a present day Medicare and Medicaid(broke) where the majority of health professionals will not treat.
Your from Texas, 45% of doctor in this state will not take Medicare patients.
Cyberbear:
I realize you have an ax to grind but why don't you take it some other place like the Daily kos or Airhead America. Forgot, It went bankrupt.
Lets go ahead and reduce that military complex thereby reducing intelligence on terrorism. Most people on the left still don't believe that Muslin groups are seeking our destruction on our home soil. We have to be politically correct not offend anybody. Richard Reed and that guy who stuck some kind of bomb down his crotch has made us all safe. Sounds like your living in "safe" La La land.
That large growth in military spending during the "Cold War" where you were probably not even born provided employment for millions of people especially minorities, my father being one of them. Those bases are closing and have been. And some of those "Texas whahoo" sure have brought thousands of job during the recession and add to the list yesterday's announcement that a Petland entity will bring in 400 jobs with average pay $57,000.
Keep dreaming that government will be your savior.
Did you try Blue Cross Blue Shield. I have gotten covered when unemployed. yes pay higher premiums but protects me from disaster. Hard to believe you could not get any coverage unless you are one of those 8 million Americans with chronically health problems that no will provide.
Medicaid like Social Security has been a very successful and popular federal program. Failing to appropriately tax the rich has cost us trillions of dollars that could have been used for programs and deficit retirement. And big-money initiated talking points, filtering through groups like "Heritage" Foundation and the Republican Party have perverted some of the public's perception of these issues.
People should stand up for their interests and tell their congressmen to push to collect taxes on the top 10% money makers, and fund not cut programs in education, health care, social security, transportation, NPR.
Look what we accomplished 1940-1980, and look how government has been attacked and deneutered since 1980. Since 1980 the gap between the rich and poor has broadened and the middle class has evaporated.
Don't let the Corporate voice to cut government and deregulate, and cut taxes for the rich, distort and derail the true issues that effect us all.
Social Security was a solvent program until 1966 when the Democratic s decided to borrow off the program to pay for the Vietnam War and the Great Society "The War on Poverty. We were told in 1967 when Medicare was created that in 20 yrs the program would not cost more than 100 Billion. It is 10 that much today and stated to be in the red by 2017.
Today 29 Billion is going out than going in S.S benefits. The Chinese do not want to lend the uS any more money .
1% of the top earners in the US pay 38% of the total Tax bill. 10% of the top earners in the us pay 90% of the taxes. 50% of the US do not pay any taxes at all.
At the end of 1980 and Carter, inflation was 21% and 18% interest rates.
The American tax payer voted on November 2nd by electing 63 Republican congressmen and women to stop this insanity in spending which will equal 90 cents to the dollar in paying off debt by 2020.
Thank you America for waking up.
Governor Perry of Texas wants to opt out of Medicaid, but he still wants the Federal Government to continue sending Texas the money so that it can run its own program. If this were to happen, what would stop Texas from cutting its program with the aim of driving the needy to states with more generous programs? The answer is nothing, and this is one of the major reasons that the Federal Government rightly requires states to conform to certain regulations in order to receive Medicaid funds.
One of the biggest problems with Medicare in Texas or other states are that their are many people that have not paid into the system but become beneficiaries. Also there are many indigent people that have been thrown into the system in recent years causing a drain on this program. What kind of mandates have been places on taxpayers(Medicare) like the recent changes to private with no caps to coverage or parent can keep a child till they are 26 years old? I don't know.
Another questions is why have the bureaucrats that run these programs have not seen this problems decades ago?
I am familiar with 4 families who have disabled, incontinent children - all school aged - who utilize the services of a CNA for up to 60 hours per week. In all cases, the parent is not working. I understand the concept of respite care, however, I do not understand why the Medicaid program pays for hours and hours of services when there is no necessity. In fact, these 4 children have become more dependent since these services have been initiated. In 1 case, student was withdrawn from a pubic school program because he was too successful and fully potty trained in this environment. In another case, the parent and CNA have insisted that the child wear diapers at school and have discontinued all attempts to potty train. Home health care companies are loathe to report fraud, because they have a financial interest. Whenever the possibility of cutting back on unneeded services is entertained, the word "sue" suddenly pops up in the conversation.