Tag Archives: Medicaid

Guess the main culprit of Oregon’s $623 million projected budget shortfall…

When the “Affordable” Care Act was passed, it expanded tax-payer funded health coverage through Medicaid. States that agreed to participate and expand eligibility would be reimbursed by the federal government at 100% of the costs with those reimbursement costs declining by 2020.

As Nasdaq reported in 2016, states would take a hit to their budgets once the reimbursements were reduced. From their report:

At this point, many states have seen dramatic increases in their Medicaid enrollment levels beyond original expectations, which may pose serious fiscal consequences.

While this growth speaks volumes about the progress toward meeting the federal government’s goal of increasing the number of Americans with health insurance, it arguably falls short in addressing the financial burden to state governments.

With federal reimbursement levels declining in a few years, states have largely focused on the most economical and efficient delivery methods (e.g., health maintenance organizations) to help alleviate fiscal costs going forward. Still, budgetary pressures are likely to persist. Enrollment projections were wrong and costs have exceeded expectations. That is why more than 20 states, mostly conservative, Republican-dominated states, opted out of joining the ACA program and are now enjoying an “I told you so” moment after analyzing the program’s fiscal costs.”

Oregon Live reported on Tuesday that the state’s general fund and lottery revenues could total $23.6 billion from 2019 to 2021, a 5 percent increase from the current budget, yet the state could still go $623 million in the red, according to a tentative budget overview from the Legislative Fiscal Office and Department of Administrative Services.

And the main cause of this deficit? Rising costs for the state’s Medicaid program. From their report:

Under the Affordable Care Act, states such as Oregon that expanded Medicaid must pick up a greater share of the cost over time. Existing taxes that fund the program are also set to wind down.”

Adding to that deficit is education costs that will increase due to the passage of Measure 98 in 2016. That will result in an increase in spending on the programs by $147 million annually.

How’s that “big f*cking deal” working out for you now, demorats?

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New Trump rule would deny green cards to immigrants who took food stamps, Medicaid

Works for me.

From NBC: The Trump administration announced a proposed rule Saturday that would make it harder to obtain visas or green cards for immigrants already in the U.S. legally, as well as those seeking to enter, if they have ever been dependent on certain public benefits, like Medicaid, food stamps or public housing.

The proposal, which can become a rule after a public comment period, rewrites a 1999 rule that limited green cards for immigrants who were dependent on cash benefits, but did not take into consideration health care or other non-monetary benefits.

Originally, the rule known as “public charge” began in the 1800s as a way for the U.S. to deny entry to immigrants who were likely to become a drain on the economy.

“This proposed rule will implement a law passed by Congress intended to promote immigrant self-sufficiency and protect finite resources by ensuring that they are not likely to become burdens on American taxpayers,” said Department of Homeland Security Secretary Kirstjen Nielsen.

As NBC News previously reported, earlier versions of the proposal included more draconian measures, such as limiting green cards and citizenship for immigrants who had used Obamacare or certain tax credits.

“The [disqualifying] benefits generally represent the largest federal programs for low-income people by total expenditure that address basic living needs such as income, housing, food, and medical care,” a spokeswoman for DHS said in a written briefing.

Read the rest of the story here.

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California bill would create health care price controls

government solve all problems
But, but…I thought Obamacare was suppose to reduce the cost of health care?
From Sacramento Bee: California’s government would set prices for hospital stays, doctor visits and other health care services under legislation introduced Monday, vastly remaking the industry in a bid to lower health care costs.
The proposal, which drew swift opposition from the health care industry, comes amid a fierce debate in California as activists on the left push aggressively for a system that would provide government-funded insurance for everyone in the state.
Across the country, rising health care costs have put the industry, lawmaker and employers and consumers at odds.
The proposal in California would affect private health plans, including those offered by employers and purchased by individuals. A nine-member commission appointed by the governor and legislative leaders would set prices for everything from a physical exam to an allergy test to heart bypass surgery. No other state has such a requirement.
“If we do not act now, I’m concerned that health care prices will become unsustainable,” Assemblyman Ash Kalra, a freshman Democrat from San Jose who wrote the legislation, said in a news conference in Sacramento.
The measure faces an uphill battle in the Legislature, where lawmakers are generally cautious about making drastic changes to the health care system and are already juggling a wide range of ambitious proposals.
The proposal is backed by influential unions including the Service Employees International Union, Unite Here and the Teamsters. The unions are frustrated that health care costs are gobbling an increasing share of employee compensation.
“Every dollar that we spend on rising health care prices is a dollar that comes out of a worker’s pocket,” said Sara Flocks, policy coordinator for the California Labor Federation, a union coalition. “This is something that is eating up our wages and it is increasing income inequality. This is a fundamental question of fairness.
Health care providers say price controls would encourage doctors to move out of state or retire, making it harder for people to see a physician when they’re sick, and force hospitals to lay off staff or, in some cases, close their doors.
The California Medical Association, which represents physicians, called the proposal “radical” and warned that it would reduce choices for consumers.
“No state in America has ever attempted such an unproven policy of inflexible, government-managed price caps across every health care service,” Dr. Theodore Mazer, the CMA president, said in a statement.
Under Kalra’s bill, prices would be tied to Medicare’s rate for a particular service or procedure, with that price as a floor. There would be a process for doctors or hospitals to argue that their unique circumstances warrant payments higher than the state’s standard rate.
Paying hospitals 125 percent of Medicare’s rate would cut $18 billion in revenue and force them to trim nurses and other support staff, said Dietmar Grellman, senior vice president of the California Hospital Association. Private insurers make up for the low payments from government-funded health care, which doesn’t cover the full cost of care, he said.
“That’s why their bill is such an empty promise,” Grellman said. “They take money out of the system with rate regulation, but then they don’t address the huge gaping hole that’s created by Medicare and Medicaid.”
In recent decades health care spending has risen faster than inflation and wages while employers and health plans have shifted more of the costs onto consumers through higher premiums, deductibles and copays. Americans spend more per capita on health care than other developed countries.
Meanwhile, a wave of consolidation by hospitals, physician groups and insurance companies has given industry players more power to demand higher rates.
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Thousands mistakenly enrolled in California's Medicaid expansion

you don't say
Shocker, not.
From CNN Money: California signed up an estimated 450,000 people under Medicaid expansion who may not have been eligible for coverage, according to a report by the U.S. Health and Human Services’ chief watchdog.
In a Feb. 21 report, the HHS’ inspector general estimated that California spent $738.2 million on 366,078 expansion beneficiaries who were ineligible. It spent an additional $416.5 million for 79,055 expansion enrollees who were “potentially” ineligible, auditors found.
Auditors said nearly 90% of the $1.15 billion in questionable payments involved federal money, while the rest came from the state’s Medicaid program, known as Medi-Cal. They examined a six-month period from Oct. 1, 2014, to March 31, 2015, when Medicaid payments of $6.2 billion were made related to 1.9 million newly eligible enrollees.
There were limitations to the California review, however. The audit extrapolated from a sample of 150 beneficiaries. The authors reported a 90% confidence level in their results — whereas 95% would be more common. That meant that the number of those ineligible could have been as low as 260,000 or as high as 630,000.
“If HHS has a strong reason to believe that California is systematically making enrollment errors, it would be helpful to show that in a more robust analysis,” said Ben Ippolito, a health care economist at the American Enterprise Institute, a conservative think tank. “The federal government should ensure that states are being good stewards of federal money.”
Nonetheless, the audit highlighted weaknesses in California’s Medicaid program, the largest in the nation with 13.4 million enrollees and an annual budget topping $100 billion, counting federal and state money. Medicaid covers one in three Californians.
The inspector general found deficiencies in the state’s computer system for verifying eligibility and discovered errors by caseworkers. The Medicaid payments cited in the report covered people in the state’s fee-for-service system, managed-care plans, drug treatment programs and those receiving mental health services.
California’s Department of Health Care Services, which runs Medi-Cal, said in a statement that it agreed with nearly all of the auditors’ recommendations and that the agency “has taken steps to address all of the findings.”
In a written response to the inspector general, California officials said several computer upgrades were made after the audit period and before publication of the report that should improve the accuracy of eligibility decisions.
Among the 150 expansion enrollees analyzed in detail, 75%, or 112, were deemed eligible for the Medicaid program in California. Auditors discovered a variety of problems with the other 38 enrollees.
During the audit period, 12 enrollees in the sample group had incomes above 138% of the federal poverty line, making them ineligible financially for public assistance, according to the report.
In other instances, beneficiaries were already enrolled in Medicare, the federal health insurance for people 65 and older or who have severe disabilities, and did not qualify for Medi-Cal. Onewoman indicated she didn’t want Medi-Cal but was enrolled anyway.
In 2014, the state struggled to clear a massive backlog of Medi-Cal applications, which reached about 900,000 at one point. Many people complained about being mistakenly rejected for coverage, or their applications were lost in the state or county computer systems.
California was one of 31 states to expand Medicaid under the 2010 Affordable Care Act. The health law established a higher federal reimbursement for these newly eligible patients, primarily low-income adults without children. After expansion started in 2014, the HHS inspector general’s office began reviewing whether states were determining eligibility correctly and spending taxpayer dollars appropriately.
Read the rest of the story here.
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Washington state senate approves bill mandating abortion coverage

abortion-rights
Demorats: Making sure somebody pays for (my body) my choice.
From MyNorthwest.com: The Washington State Senate approved a bill that would require health insurers covering maternity care to also cover abortions.
“Washington has long led the way on this issue, and passing the Reproductive Parity Act (RPA) will be yet another example of that,” said state Sen. Steve Hobbs (D-Lake Stevens), who introduced the bill this legislative session in Olympia. “It should pass, and we should move quickly on it because these days it’s really anybody’s guess as to what the Trump administration will or won’t do next.”
Hobbs, along with Rep. Eileen Cody (D-Seattle), in the House, have introduced this bill in the upper chamber for years, but it hasn’t passed despite some bi-partisan support. When it was first discussed in 2012, it failed 26-23. With Democrats recently taking control of the Washington state Senate, Hobbs believes that the shift in power will lead to swift passage.
Washington state already has laws in places that protects reproductive health rights; voters passed an initiative in 1991 that would keep protections in place for women in the event that Roe v. Wade is overturned. What SB 6219 focuses on is affordability of coverage.
The average cost for an abortion is around $650, and the monthly income of a full-time, low-wage worker in the Puget Sound region is $1,400, according to The Northwest Abortion Access Fund – an organization that helps women pay for care.
Activists say that this bill is a step forward to help alleviate the cost of an abortion for many women so they don’t have to seek additional financial help. It would also set up a type of reimbursement program for women — including non-citizens — without insurance or who are on Medicaid.
But some families will still be left with high deductibles. Also, when a woman passes a certain point age of pregnancy, the cost increases.
But right now, Rogers (I don’t know who this Rogers person is; not previously identified in this article) says with facing potentially harmful federal restrictions under the Trump administration on funding for legal abortion, the RPA would make sure that state law applies as broadly as possible without violating those restrictions.
Some believe taxpayers aren’t responsible for funding this
Human Life of Washington — a right to life group — strongly opposes RPA. Its government relations expert Sarah Davenport-Smith says it forces taxpayers who are against contraception and abortion to pay for something they don’t support.
According to Davenport-Smith, while abortions and abortifacient drugs are legal, there is no requirement for taxpayers to fund them.
Why supporters think this needs to pass now
The political climate is also why the bill covers several rules for birth control access, said Executive Director Tiffany Hankins of NARAL Pro-Choice Washington, a chapter of a national organization that supports women making personal decisions about their reproductive health.
Many of these rules ensuring contraceptive equity and affordability already exist through the Washington state insurance commissioner’s office. Under their rules, most health plans currently must cover Food and Drug Administration-approved contraceptive methods prescribed by their in-network medical provider, and this is without people having to deal with copays, deductibles, and coinsurance.
But having these rules in a bill would strengthen those rules. People could see changes as soon as 2019 if the bill passes. It specifically applies to a health plan issued or renewed on Jan. 1, 2019.
Read the rest of the story here.
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Cuomo wants taxpayers to pay for illegal aliens go to college

cuomo and sanders

The party promising free stuff to illegals on your dime!


New York tax dollars at work.
From NY Post: Gov. Andrew Cuomo wants to give another break to immigrant Dreamers by extending free public college tuition to students who were brought into the United States illegally as kids.
Cuomo tucked a provision in his $168 billion budget plan that would amend state education law to make the undocumented students illegal aliens eligible for the Excelsior Scholarship program, which covers tuition costs for students from families with incomes of up to $125,000.
On Tuesday, he said the state would continue providing Medicaid to Dreamers regardless of any federal changes to the Deferred Action for Childhood Arrivals program, or DACA.
But Republicans in the state Senate said they won’t go along with Cuomo’s latest idea.
“We don’t support giving free college tuition to people who are here illegally,” said Senate GOP spokesman Scott Reif.
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Perpetual blame game: Clinton suggests Bernie Sanders resorted to "innuendo and impugning my character" to gain ground in the primary

hillary-clinton-screams-why-arent-i-50-points-ahead

Hillary the loser.


Must suck to be so bitter.
From Daily Mail: Hillary Clinton‘s frustrations with Bernie Sanders spill out onto the pages of her forthcoming book, What Happened, as she gripes about his campaign tactics and the fact that he was never truly a Democrat. 
‘Because we agreed on so much, Bernie couldn’t make an argument against me in this area on policy, so he had to resort to innuendo and impugning my character,’ Clinton writes, according to a page tweeted out by journalist and CauseWired founder Tom Watson.
The Vermont senator, Clinton charged, laid the foundation for Donald Trump‘s ‘Crooked Hillary’ charge against her, and didn’t have the future of the Democratic Party in mind during his run.
‘Some of his supporters, the so-called Bernie Bros, took to harassing my supporters online. It got ugly and more than a little sexist,’ Clinton recalled.
During the primary, Sanders would often hint that Clinton was corrupt because of financial donations she took from Wall Street and other large companies. ‘When I finally challenged Bernie during a debate to name a single time I changed a position or a vote because of a financial contribution he couldn’t come up with anything,’ Clinton noted.
‘Nonetheless, his attacks caused lasting damage, making it harder to unify progressives in the general election and paving the way for Trump’s “Crooked Hillary” campaign,’ she said.
Clinton wondered aloud if Sanders even cared, as he considered himself a Democratic Socialist, and not a Democrat, and thought about running for president as an independent.  
‘I don’t know if that bothered Bernie or not,’ she said. ‘He certainly shared my horror at the thought of Donald Trump becoming president, and I appreciated that he campaigned for me in the general election.’
‘But he isn’t a Democrat – that’s not a smear, that’s what he says,’ Clinton continued.’
‘He didn’t get into the race to make sure a Democrat won the White House, he got in to disrupt the Democratic Party,’ she noted.
Clinton said Sanders was right that the Democratic Party needed to pay more attention to working families.  And she also pointed out that there’s a ‘danger’ in spending too much time fundraising, though blamed it on the country’s ‘insane campaign finance system.’
Clinton also gave credit to Sanders for bringing a lot of young people into the political process.
‘But I think he was fundamentally wrong about the Democratic Party – the party that brought us Social Security under Roosevelt; Medicare and Medicaid under Johnson; peace between Israel and Egypt under Carter; broad-based prosperity and a balanced budget under Clinton; and rescued the auto industry, passed health care reform and imposed tough new rules on Wall Street under Obama,’ Clinton noted.
‘I am proud to be a Democrat and I wish Bernie were, too,’ Clinton said. 
Read the rest of the story here.
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Senator Maria Cantwell (Demorat – WA) fails spelling


There’s a reason many in Washington state call her “Cantdowell.”
h/t Laura
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Oregon approves measure requiring insurers to cover abortion

unborn baby

“No cost” for abortion…

From Fox News: Insurance companies in Oregon would be required to cover abortions and other reproductive services at no cost to the patient regardless of income, citizenship status or gender identity under a measure approved Wednesday by lawmakers.
Oregon already has some of the most liberal abortion laws in the U.S., leaving out otherwise common requirements for waiting periods or spending limits on taxpayer funds.
The measure, which does offer some religious-based exemptions, comes as the federal government and other states are seeking restrictions on abortion services.
President Donald Trump earlier this year signed legislation allowing states to withhold federal family planning funds from Planned Parenthood and other abortion providers. In May, the Texas Legislature approved a sweeping package of new abortion limits.
Oregon’s legislation has been in the making for years but was introduced in early March largely in response to Republican congressional leaders’ earliest attempts to repeal former President Barack Obama’s health care law, which includes minimum coverage requirements for birth control and other reproductive services.
The Democratic-controlled Oregon Senate approved the measure in a 17-13 vote along party lines. It now heads to Democratic Gov. Kate Brown.
The bill would also allocate almost $500,000 over the next two years to expand cost-free reproductive health coverage, including abortions, to immigrants who are otherwise ineligible for Medicaid.
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ObamaCare fallout: As premiums rise, so does cost to taxpayers

Going as planned.
obamacare2
From Fox News: The Obama administration is trying to calm the panic over soaring ObamaCare premiums by pointing to subsidies many will receive to offset the cost — but analysts and GOP lawmakers counter that those subsidies nevertheless will stick taxpayers with a rising bill. 
With enrollment set to begin Nov. 1, the administration announced Monday that premiums are set rise an average of 25 percent across the 39 states served by the federally run online market. Some states, such as Arizona, will see premiums jump by as much as 116 percent.
Department of Health and Human Services officials are stressing that subsidies provided under the law, which are designed to rise alongside premiums, will insulate most customers from sticker shock.
But the rising cost of subsidies, which already totals tens of billions a year, would be passed on to the taxpayer.
“Taxpayers are already in for a lot,” Tom Miller, resident fellow at the American Enterprise Institute, told FoxNews.com. “The cost doesn’t go away, it just goes into someone else’s pocket.”
In a March report, the non-partisan Congressional Budget Office estimated that subsidies given to enrollees in 2016 would amount to $43 billion in 2016, and predicted the cost would rise to $106 billion by 2026. It also said that over 10 years, ObamaCare provisions would reduce the deficit thanks to tax provisions and cuts to Medicare. That was before the latest announcement by the administration. It’s unclear how exactly the looming premium hikes will affect that picture, though Republicans are now seeking new estimates.
Analysts say it’s safe to assume taxpayer costs will rise. Miller noted that HHS reported an average subsidy of $291 per month in 2016. A 25 percent increase in premiums would theoretically translate into an extra $73 per month, or about $870 a year per person.
you don't say
“If you assume conservatively that there’s 10 million people getting subsidies, that’s an extra $8.5 billion in extra costs taxpayers are getting hit by going into next year,” he said.
Other experts warned this is likely to continue as long as premiums keep rising. “Its real simple, premiums are going up and up, and subsidies are going to go up with them,” Douglas Holtz-Eakin, president of the American Action Forum and a former CBO director, told FoxNews.com.
The Department for Health and Human Services, when asked for comment by FoxNews.com, noted that the law’s coverage provisions are set to cost 28 percent less in 2019 than the CBO originally projected, amounting to about $49 billion less than originally predicted when the law was signed in 2010. A spokesman also said the same office predicted that repealing the law would increase the deficit by approximately $350 billion over 10 years.
Holtz-Eakin urged caution on the administration’s analysis. “It’s been a mixed pattern, because the enrollments haven’t been what they expected so it hasn’t been as big of an impact financially,” he said. “The bad news is that spending per person is much higher than anticipated due to subsidy increases because of premium hikes.”
Obama signs Obamacare bill
One of the biggest ObamaCare costs to taxpayers has been absorbed into the Medicaid budget, paid for by both state and federal governments. As a sweetener to get states to go along with the plan, the federal government offered to pick up the cost of expanding Medicaid eligibility up to 133 percent of the poverty line. That siphoned low income — and expensive – customers away from ObamaCare exchanges, seemingly contributing to its current solvency. But that cost – in the hundreds of billions — also is borne by taxpayers.
The CBO projected in 2013 that, in part due to ObamaCare, federal Medicaid spending would more than double over the next 10 years, topping $554 billion by 2023. State governments pay another $160 billion toward Medicaid. “Volume has been greater in Medicaid, and per person costs have been much higher than expected,” Edmund Haislmaier, senior fellow at the Heritage Foundation, told FoxNews.com.
Sensing a spike in taxpayer costs, the Republican-led House Committee on Energy and Commerce has written to the Centers for Medicare and Medicaid Services demanding how much taxpayer money will be spent subsidizing the cost of rising premiums.
“While the Administration continues to focus on premium ‘affordability,’ it ignores the undeniable fact that federal taxpayers are subsidizing these premium increases through tax credits,” the letter from Chairman Fred Upton, R-Mich., says. “The Committee is concerned that the federal taxpayer continues to bear the burden of subsidizing the growing cost of health care insurance.”
The committee is demanding estimates of the amount of money spent covering rising premiums by Nov. 7.
obamacare
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