Arizona will participate in the expansion of Medicaid, Gov. Jan Brewer said Monday in her State of the State address, making her the third Republican governor to agree to one of the key components of President Barack Obama’s health care reform.
Brewer said that if she did not accept the Medicaid funds for Arizona, other states could claim those federal dollars and create jobs that otherwise would be created in Arizona. Fellow Republican governors Susana Martinez of New Mexico and Brian Sandoval of Nevada also plan to expand Medicaid to anyone who earns up to 133 percent of the federal poverty level, which is currently $14,856 for an individual.
But 10 other Republican governors have already decided not to participate. The Supreme Court’s 2012 ruling that affirmed Obama’s health care law allows states to refuse to take part in the Medicaid expansion.
Three Republican governors that are able to see reason. About taking federal money, at least.
Interesting Wonkblog post profiling how Health Quality Partners in PA has lowered Medicare costs while improving outcomes & reducing hospitalizations for seniors; so naturally, Medicare is trying to kill the program.
Wait - what?
Also partially explores why health-care reform - and in particular curbing costs - is so hard. Hint: follow the money - who makes it and how.
Fine article, thanks for sharing. This bit struck me in particular:
But not all hospitals are run by the local Village Improvement Association. Many seek to turn a profit. That makes models like Health Quality Partners something of a threat. “If we scaled what Ken is doing,” Brenner says, “you would probably shut down a third of the hospitals in the country. It’s a disruptive innovation. It just guts the current business model.”
In a nutshell, this is why I support the idea of a single-payer, not-for-profit healthcare system. Putting healthcare in the hands of private for-profit business naturally leads to whatever makes the most money, which is not the same as the best health. The greatest set of incentives in the world won’t be able to make sure that the best health is always the same as the most money.
I’d be wary of visiting nurse services. I agree that human care yields good results compared with expensive drugs / technology. There’s too much pressure from both suppliers and patients (PURPLE PILL ADS!).
The conservatives like to project their disdain on how unaffordable it is for other people to get insurance from what is their point of view, THEIR labor. The poor janitor doesn’t earn enough to cover his health costs, so he much leech from the labor of the partners upstairs who yield more tax revenues.
The only real way to cut costs would be to remove expensive drugs and technology from the table. I suspect the death panel charge was orchestrated to make sure any real cost control was struck off the table.
How different is the HQP from visiting nurse services or home care attendants we use in New York? Is it because they have very high quality nurses? Or do nurses always have a positive, unacknowledged impact?
Results of an Oregon study on low-income Medicaid recipients is out, and the difference in the media coverage is striking. The basic facts:
The research, published Wednesday in the New England Journal of Medicine, did find that low-income people who recently gained Medicaid coverage in Oregon used more health-care services.
New Medicaid enrollees had less trouble paying their bills and saw significant improvements in mental health outcomes, with rates of depression falling by 30 percent.
But on a simple set of health measures, including cholesterol and blood pressure levels, the new Medicaid enrollees looked no different than a separate group, who applied for the benefit but were not selected in a lottery.
Some news outlets use this as a cudgel to beat up Obamacare, others are happy to see better financial and mental health outcomes.
What’s striking to me is that in all of these stories (at least, that I noticed while skimming them) there are two things either not mentioned at all, or just mentioned in passing:
A timeline of two years is pretty short to see major shifts in physical factors like cholesterol and blood pressure, except in the most dire of cases. Changing those indicators is a lifestyle change, and just getting health coverage from the government doesn’t change the fact that you’re still poor and unlikely to be able to make those lifestyle changes with ease. Only people who were in bad enough shape to get the “shape up or die” speech from their doctor probably had enough incentive to make the sacrifice required to make those serious changes in a low-income situation.
Getting Medicaid coverage doesn’t actually mean you get decent health care. You still have to deal with our poorly incentivized, money-first health system. Is it any wonder that the main benefit to people was financial? (And mental health, most notably depression, which certainly would be related to having financial issues.) The whole system is built around making money, so of course a band-aid like the ACA which focuses on getting more people into the system rather than structural reform would have the biggest impact on the biggest problem - money.
The problem is the way you (over) use healthcare in America because of the way the system works (as has been extensively documented…I think there was a good Slate article on it…), but detail! Also, of course, it’s overlooking the people with chronic problems who can now get cover.
We’ve got a real media battle going on here in Michigan over the Medicaid expansion coming along with the ACA. Governor Snyder is pretty unhappy that the state Senate is refusing to even vote on the issue, and he’s taking his show on the road. It’s been on the local news repeatedly, and Snyder seems to be pretty serious about fighting his Republican comrades over it. Will it go anywhere? I have my doubts, since there’s really only one person (Senate majority leader Randy Richardville) who can do anything about getting this to a vote, and he’s shown no sign of wanting to change his mind.
The fierce struggle among Republicans over whether to make Medicaid available to more low-income people played out in Michigan on Tuesday as the Republican governor, Rick Snyder, narrowly succeeded in swaying enough conservative senators in the State Legislature to accept the expansion, which was part of President Obama’s health care law.
Mr. Snyder’s preferred bill — one he had lobbied for intensely for months — initially fell short by one vote, but the governor salvaged a deal hours later. The vote in the Republican-controlled Senate was 20 to 18, with only 8 Republicans in favor. The Michigan House, which had earlier approved a similar measure, will need to vote on the Senate version before Mr. Snyder can sign the bill.
It’s a bit more of a gamble than you make it out to be. The money is “totally free” for the first three years, then the states are expected to pick up 10% of the cost for those who became eligible under the ACA. For states that are already experiencing budget difficulties, like California and Illinois, that 10% may represent a major hurdle. Also the free money has only been funded through 2015. Will Congress, given that its political makeup is not likely to change much between now and then, come through with the rest of the money or are the states going to be on the hook for these newly eligible recipients? That has yet to be answered.
Whenever you see a reference to a Charlie Pierce political blog post, you can assume there’s some tongue-in-cheek involved. :)
Having said that, it still seems like a pretty good deal. This CHRT report shows a savings over 10 years of about $1 billion for Michigan. That assumes the federal government actually pays its part, but if it doesn’t, it would be reasonable to assume the states will simply refuse to pay the federal portion and the programs die from lack of funding. (Not that I would support that, but I expect that’s how it would play out.)
Of course, most of those savings will be realized from a projected reduction in insurance premiums due to a projected reduction in healthcare costs. As this Washington Post blog notes, we really don’t know if that’s how it’s going to play out. As for the states simply refusing to pay if the feds don’t come through, it’s difficult, to say the least, for politicians to tell constituents who are already receiving benefits that they’re being cut off.
You’re right that we don’t know how it’s going to play out, and given that both alternatives involve unknowns, I’d prefer to err on the side of taking federal money while it’s available and providing better health care for a bunch of my fellow Michiganders at the same time. I’m glad the state Senate was finally convinced to see things the same way.
Regarding the business of why our health care inflation is so completely out of hand here in the US, there was a recent Fresh Air interview with a reporter (formerly trained as a physician, or had maybe even been a doctor for a while) who looked into it. What she found was that so many times in our system everyone bills for everything separately, where in other systems it’s just assumed that certain costs are rolled in/included in say, a hip replacement surgery (instead of having a separate “operating room fee” etc.). Naturally when things are billed separately like that what happens is there’s a separate markup charged on every good/service provided. We’ve got to change that paradigm in order to get a handle on costs.
Neat little look at the Affordable Health Care Act and how it’s performed vs the worst-case scenarios hypothesized by skeptics. Nice way to mark the fifth anniversary of it being signed into law:
To be honest it may be 5 years old but it I am not even sure all of it’s programs have been fully implemented. I think this is the first year there are tax consequences if you don’t get insurance.
In September 2009, President Obama addressed Congress, vowing that his healthcare plan would “slow the growth of healthcare costs for our families, our businesses, and our government.” But costs for all three have actually grown.
Obamacare has done nothing to reduce health care costs, but again only 5 years and the program has really not been in full force for much of that. If anything many people have reduced their benefits because of the packages offered. Locally, since California has enrolled many people finding a new doctor can be a daunting effort.
On a quick glance, that Forbes article seems to have several problems.
Obama states that it will slow not eliminate, healthcare costs. Even there, when you drill down to the article’s argument on healthcare cost growth, you find that it relates to overall healthcare cost growth, not per capita growth. When I hear “slow the growth of healthcare costs for [my] family”, I think of per capita costs growth rates, which, if IIRC, have dropped since the ACA. This first point gets back to the criticism that the Republicans still haven’t addressed: what is their solution to the ever-increasing per capita costs of healthcare that well-outpaced inflation?
On the overall healthcare cost growth issue, the data relied on is 1) complicated by the Great Recession, and 2) isn’t necessarily a bad thing since we added a crap load of people to ranks of the insured through both employer healthcare plans as the economy picked up and because of the ACA. For 2), people getting the healthcare they need (but previously couldn’t afford because of lack of insurance) is a good thing.
