Obamacare: Medicaid by Nancy Thorner and Jane Keill

August 7, 2012

Obamacare: Medicaid  by Nancy Thorner and Jane Keill

 Medicaid is the Federal and state government program which provides medical care for the poor, some elderly and some disabled people. It is called MediCal in the state of California and some 29% of California’s population is in Medical. Every state has a Medicaid program already established for their poor or disabled residents. www.colorado2.com/medicaid/states.html

 Under Obamacare, those states that accept the new Medicaid provision of the health care bill would have to accept new uninsured patients above and beyond the participants they already have in their state program. The Federal government would pay the costs for the first three years of the Obamacare Medicaid implementation. This 100 percent funding rate will phase down to 95 percent in 2017, 94 percent in 2018, 93 percent in 2019, and 90 percent in 2020. After that, the individual states would have to begin paying up to 10% for Medicaid costs, an expense most of them cannot afford. www.forbes.com/sites/aroy/2012/07/23/how-do-blue-states-expand-medicaid-by-paying-doctors-less/

A new Kaiser Family Foundation poll released on Tuesday, July 31, 2012, found that 67%, or 2 out of 3 voters, gave a favorable view of President Obama’s healthcare provision to expand the existing Medicaid program to cover more low-income, uninsured adults. When poll participants were asked, however, whether they favor Medicaid expansion in their home state, support dropped to 49%. A slight majority preferred the status quo when told an expansion of their state’s Medicaid program could cost their own state money. http://www.kaiserhealthnews.org/daily-reports/2012/july31/kff-tracking-poll.aspx

There are reportedly 30,000,000 people in the US without health care. Approximately, ½ of those people would be eligible for medical assistance under the new Medicaid rules. Most of the state programs are already broke and with more and more generous mandates for coverage required by the Federal government, more and more budgets will be eaten up by costs for their programs.

In some states, adding in new eligible Medicaid patients to their programs will more than double their participants, straining or breaking budgets that are already stressed. Under Obamacare, single people who make less than $14,857 would qualify for Medicaid, as would a family of four that brings homes less than $30,657. https://www.google.com/search?q=Eligiablity+for+Medicaid%3A++Single+-+%2414%2C857++A+family%3A++%2430%2C657&ie=utf-8&oe=utf-8

When the Democrats wrote and passed the Affordable Care Act (Obamacare), they forgot to put into it a requirement that the 50 states must accept newly eligible Medicaid participants and provide the coverage for all those people who don’t have health care.

When the Supreme Court made its recent decision on the constitutionality of Obamacare, they pointed this out and said the various states DO NOT have to accept the Medicaid changes in Obamacare. The Supreme Court decision also said the Federal government couldn’t punish the states who do not accept the changes by withdrawing existing funds that are available for the Medicaid programs already in place. http://www.forbes.com/sites/aroy/2012/06/28/why-the-supreme-court-decision-on-obamacare-may-dramatically-increase-the-deficit

As of July 2012, twelve states (TX, WI, FL, GA, IA, KS, IN, LA, MS, SC, NJ, SD) have indicated they will not accept the new ACA Medicaid requirements, or are considering not doing so until after the November election. In those states which will not accept the Obamacare requirements, this means those people who have been uninsured, will continue to be uninsured. So, why was Obamacare passed? To provide health care coverage for the uninsured. Yet now, if some states don’t accept the Obamacare Medicaid provision, those uninsured still may not have health coverage http://thinkprogress.org/health/2012/07/02/509464/gop-governors-may-turn-down-258-billion-in-obamacare-funds-leave-92-million-americans-uninsured/

Many people argue that those who don’t have health coverage go to the Emergency Room, and we have to pay for them. Those who say we should have national health care which will cover these people, don’t realize that we will still pay for them anyway. Either way, we are going to be paying for the uninsured people.

One of the major costs of Medicaid coverage is the cost of nursing homes. The Medicare program only covers nursing home expenses if the patient is receiving active nursing and medical care. If an indigent patient is unable to care for themselves on a daily basis, but doesn’t require actual nursing care, then Medicaid is used to pick up the costs. Medicaid is the nation’s largest payer of nursing home care. (Chicago Tribune 7/31/12) The elderly are the most expensive group of people who are covered for Medicaid health costs. The average child on Medicaid costs about $2,900 a year, but an average elderly person costs $16,000. (Chicago Tribune 7/31/12) http://www.latimes.com/news/nationworld/nation/la-na-medicaid-rollback-20120731,0,1410769.story?page=1

More and more doctors are beginning to refuse treatment for Medicaid patients because the doctors are only reimbursed at roughly 60 cents on the dollar. In addition, they do not usually have the staff available to process the state and Federal claim forms necessary to obtain what little reimbursement they do get. Like those doctors who are already beginning to limit their Medicare patients, these physicians cannot continue caring for the poor and disabled. They simply cannot treat the Medicaid patients at these costs. www.ncpa.org/sub/dpd/index.php?Article_ID=22138

What’s notable is that of the ten Medicaid States (including D.C.) that pay doctors the least, relative to private insurers, nine are reliably blue states: New York (29%); Rhode Island (29%); New Jersey (32%); California (38%); D.C. (38%); Florida (44%); Illinois (46%); Minnesota (46%); and Michigan (47%).

In contrast, of the ten states that pay doctors the most, nine usually vote red: Alaska (113%), Wyoming (94%); Idaho (82%); North Dakota (81%); Delaware (80%); Oklahoma (80%); New Mexico (79%); Arizona (78%); Montana (77%); and North Carolina (76%).

Admittedly, there are some blue states that pay their doctors well, like Delaware does, and some red states, like Texas, which doesn’t. http://www.forbes.com/sites/aroy/2012/07/23/how-do-blue-states-expand-medicaid-by-paying-doctors-less/

Notwithstanding, many states have already begun to cut their Medicaid programs because they’re in financial trouble. Illinois had a record-setting $13 billion deficit in Medicaid, with an overall $2. 7 billion gap in Medicaid funding. Recently Illinois legislators passed budget adjustments which slash $1.6 billion from the state’s Medicaid program.

Illinois’ current Medicaid program has ballooned to cover 3 million citizens. The 2010 census recorded 12,830,632 people in Illinois, which suggests that potentially 5 million people could be enrolled in Illinois Medicaid by 2013 under Obamacare. www.huffingtonpost.com/2012/05/25/illinois-medicaid-cuts-le_n_1546668.html

If 5 million new Obamacare Medicaid participants were enrolled in Illinois, the costs would increase proportionately to $21.8 billion or roughly half of the 2012 operating budget of $52.8. And Illinois is already a basket case financially! It has been estimated that once implemented, 40% of U.S. citizens will be on Medicaid. blogspot.com/2012/04/Illinois-medicaid-perfect-storm.html

In Illinois, letters were sent out to more than 25,000 working parents in June 2012 to tell parents that starting July 1 they would lose their state-provided health coverage. www.sj-r.co/x2067834138/Brisk-cut-off-for-Illinois-parents-on-Medicaid

One of the cuts being made in the Illinois Medicaid program is in the number and amount of drugs that can be issued to a given patient. In Illinois, there will be a maximum of four drugs prescribed per month for a patient, even if they need more than that to function effectively or to survive. To obtain more than four prescriptions, the patient would have to get prior approval through a Medicaid system that is already overloaded, inefficient and ineffective. www.huffingtonpost.com/2012/05/25/illinois-medicaid-cuts-le_n_1546668.html

Other states that have placed caps on the amount of prescriptions Medicaid patients can receive include: Alabama, Arkansas, California, Kansas, Kentucky, Louisiana, Maine, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Utah and West Virginia. www.breitbart.com/Big-Government/2012/08/01/Rationing-Begins-State-Limiting-Drug-Prescriptions–for-Medicaid-Patients

Illinois’ Medicaid program will also be limiting: adult dental care, podiatric services, adult eyeglasses, adult speech, hearing and language therapy, occupational and physical therapy, inpatient detoxification, coronary artery bypass grafts and wheelchair repairs. www.alipac.us/f12/illinois-kicks-seniors-off-mediaid-keeps-illegal-immigrants-true-agenda-259335/

In case you have not yet been able process the facts: Rationing has already begun and it will only increase as time goes by.

Although Medicaid expansion is expected to extend insurance coverage to millions of previously uninsured Americans by 2013, the coverage will not necessarily translate into good health care. Local health experts doubt there will be enough doctors to meet the needs of those who live in economically depressed areas of this nation.

In truth, prospects are bleak that you will be able to keep your own doctor wherever you may live, as Obamacare expands health insurance to millions more people without significantly increasing the number of physicians or other providers. Forty five percent of practicing physicians in a September 2009 poll for Investor’s Business Daily, said they would consider leaving their practice or taking an early retirement if the Obamacare law stands.  Even without a mass exodus, the Association of American Medical colleges envisions a shortage of about 160,000 doctors by 2025. http://www.nationalriew.com/critical-condition/312694/good-luck-fin

According to Avik Roy, a Senior Fellow at the Manhattan Institute, and a frequent contributor to National Review Online:

“Governors from both parties are concerned that the costs of the expansion will be higher than projected, and that the Federal government will back out of the funding commitments.” . . . “Medicaid suffers from the developed world’s worst health outcomes. The main reason is that the program pays doctors and hospitals so little that many doctors lose money treating Medicaid patients. As a result, many doctors don’t take Medicaid patients, and people on Medicaid die sooner from cancers that could have been adequately treated at an earlier stage.”

Obamacare does include a temporary, two-year bump in Medicaid fees for primary care, expiring in 2013. Democrats hope that the bump will become permanent in the same way the Medicare “doc fix” did.  But such an outcome is hardly likely given our nation’s $1.4 trillion budget deficit. States that do go forward with Obamacare’s Medicaid expansion are almost certain to compensate for it by reducing their provider payments even further than they already are.

Not at all surprising is the rough correlation of states with extensive Medicaid programs to those with poor physician reimbursement. Mr. Roy further relates:

“Due to the way in which the Federal government provides matching funds for state Medicaid programs, states have an incentive to game the system by increasing Medicaid spending. For every dollar that a state spends on Medicaid, the Federal government spends an additional $1.33.  Fiscally irresponsible governors love that they can take political credit for expanding Medicaid, knowing that taxpayers in other states are picking up the majority of the tab.” http://www.forbes.com/sites/aroy/2012/07/23/how-do-blue-states-expand-medicaid-by-paying-doctors-less

Most uninsured blacks and Hispanics will be dumped into Medicaid, the worst health insurance program in the country, but for them there is no other option.  One wonders if those uninsured Americans who are now living in states that will choose not to adopt the Obamacare Medicaid program will eventually move to states that will accept the program. If this happens, those receiving states will become even more overloaded and out of money.

In promoting Obamacare, the security of affordable care was advanced as a talking point, but like so many of the president’s promises, his dream is better than his scheme! http://www.forbes.com/sites/merrillmatthews/2012/08/02/no-Mr-president-obamacare-will-hurt-blacks-andhispanics/


Other articles in Obamacare series:

 Obamacare:  In the Beginning        Nancy Thorner and Jane Keill    Tuesday, July 17, 2212  2012 http://illinoisreview.typepad.com/illinoisreview/2012/07/obamacare-in-the-beginning.html

Obamacare:  Death Panels            Nancy Thorner and Jane Keill   Friday, July 20, 2012
Obamacare:  You can keep your doctor    Nancy Thorner and Jane Keill  Tuesday, July 24, http://illinoisreview.typepad.com/illinoisreview/2012/07/obamacare-you-can-keep-your-doctor.html  
Obamacare:  The Popular Benefits   Nancy Thorner and Jane Keill     Friday, July 27, 2012


Obamacare:  Insurance Plans and Government Exchanges    Nancy Thorner and Jane Keill    Thursday, August 1, 2012

Obamacare:  Medicare      –   Nancy Thorner and Jane Keill    Friday, August 3, 2012




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