Medicaid is now the eye of the Healthcare storm

[Viking Prince]

This is just a single day for the Kaiser daily blog:

Jan 19, 2011
The Arizona Republic: Gov. Jan Brewer Calls Special Session On Medicaid
The Legislature will meet in special session today to give Gov. Jan Brewer authority to seek a Medicaid waiver from the federal government, the first step to cutting health care for 280,000 Arizonans. Brewer and Republican lawmakers say the move is needed to balance the state budget and keep the rest of the state's Medicaid program intact. The waiver seeks a two-year exemption, effective Oct. 1, from a requirement under federal health-care reform that states maintain current eligibility levels (Reinhart and Pitzl, 1/19).

The Texas Tribune: Texas House Budget Proposes Sweeping Cuts
The health and human services portion of the proposal would cut Medicaid provider rates — what doctors and hospitals and others are paid — by 10 percent. … There's also a $4.3 billion cut included to account for the federal stimulus money used in the current budget that's not available for the next budget. The proposal would cut a total of $16.1 billion in health and human services spending. That's a 24.6 percent cut (Staff, 1/18).

article continued

The Connecticut Mirror: Lawsuit: Medicare 'Improvement Standard' Illegally Denies Coverage To Thousands A group of patient advocates, including the Mansfield-based Center for Medicare Advocacy, has filed a class-action lawsuit seeking to end what it calls a "clandestine policy" that leads thousands of people to be wrongly denied Medicare benefits. The lawsuit, filed against U.S. Department of Health and Human Services Secretary Kathleen Sebelius, alleges that a so-called "improvement standard" is used to deny coverage of care such as physical, occupational or speech therapy to patients if their conditions are not improving, even though the standard is not supported by Medicare statute or regulations (Levin Becker, 1/19). Minnesota Public Radio: Minn. Could Still Get $1M Health Care Grant From Feds U.S. Health and Human Services Secretary Kathleen [Sebelius] says Minnesota may still get a $1 million health care grant that former Gov. Tim Pawlenty passed up last fall. Last September, Pawlenty ordered state agencies to stop applying for discretionary federal health care reform grants. That included a planning grant for Minnesota to set up a so-called health insurance exchange. ... [Sebelius] says she's working with Minnesota's new governor, Mark Dayton, on extending the deadline for Minnesota to apply (Stawicki, 1/18). St. Paul Pioneer Press: Doctors' Group Says Ranking System Is Flawed A new consumer tool from Minnetonka-based Medica is drawing fire from the Minnesota Medical Association. The health plan is set to unveil today a system for ranking doctors based on the quality and cost-effectiveness of the care they provide patients. Called the Premium Designation Program, the Medica product is based on a computer program developed by Minnetonka-based United Healthcare that is used in about 140 markets across the country (Snowbeck, 1/18). Solutions [A Colorado Health News Service]: Posh Aspen Provides Dismal Health Coverage Welcome to Aspen, land of the haves and have-nots where Gucci meets Grizzly Adams. As the national debate over health coverage takes center stage in Washington, Aspen provides a portrait of one of our nation's deepest health care divides. Poverty rates are among the lowest in Aspen, but exorbitant living expenses have made health care a luxury for many (McCrimmon, 1/18). Milwaukee Journal Sentinel: State Senate Passes Tort Reform Measure The state Senate approved a bill Tuesday that would offer individuals and businesses more protection from lawsuits -- a measure praised by the business community but condemned by advocates for the elderly and disabled as a shield for abusers (Marley, 1/18). Milwaukee Journal Sentinel: Patient Advocates Object To Nursing Home Liability Limits Tia Cheney, a 26-year-old diabetic, died in November 2009 purportedly because she was not given enough insulin while at a Port Washington nursing home. Christine Larson, her mother, is among those opposing a bill that would limit punitive damages as well as extend the current cap of $750,000 on damages for pain and suffering in medical malpractice cases to nursing homes, hospices and assisted living facilities (Boulton and Stein, 1/18). Kansas Health Institute News: Disability Groups Hatch Waiting-List Plan Disability groups have come up with a two-fold plan for significantly reducing the state's years-long waiting list for home and community based services for adults and children with developmental disabilities. ... [The plan] calls for closing two state hospitals for the developmentally disabled -- Kansas Neurological Institute and Parsons State Hospital -- and using the savings to underwrite services in the community (Ranney, 1/19). This is part of Kaiser Health News' Daily Report - a summary of health policy coverage from more than 300 news organizations. The full summary of the day's news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

http://www.kaiserhealthnews.org/Dail...e-roundup.aspx



So is this a sign that the recently passed health care reform (Obamacare) is doing more damage than good? Medicare is an expensive program for the states to fund mainly due to chronic care expenses such as child mental health and not for the everyday one trip to see a doctor.

Though when the one trip to see a doc means the emergancy room, the amount asked by the hospitals is usually cut back. The system needs to do a better job of getting the medicaid clients to be a part of a family practice and not use the emergancy room for nonemergancy cases.

Or is it the recession? Or perhaps a change in employer coverage? Or maybe a bit of everything. The following NY Times article from last month seems to place it completely on the recession.

Medicaid is the major budget-buster at the state level. As a share of the typical state budget, the program consumes about twice what it did two decades ago. The program’s funding formula encourages this: Medicaid is financed by a federal matching grant. This means that for each dollar a state adds to its Medicaid budget, the federal government will kick in from 1 to 3 additional dollars. This gives states an incentive to expand beyond the point where additional costs begin to exceed benefits.

article continued

The federal financing formula gives states a perverse incentive to expand Medicaid beyond the point where additional costs begin to exceed benefits. Adjusting for growth in health care prices, states increased spending on Medicaid by 116 percent from 1987 to 2007. From 2000 to 2007, The rate of Medicaid enrollment grew four times as fast as the general population. Once the recession hit, enrollment growth jumped to 8.5 percent in fiscal year 2010. Enrollment is up because many have lost their jobs or have had their incomes cut. But enrollment is also up because states have expanded eligibility. Before the recession began, from 2000 to 2008, 24 states expanded their Medicaid eligibility requirements. According to researchers at the Urban Institute, “higher-income parents and childless adults have been the two major expansion groups.” In 2001, for example, New York adjusted its requirements so that the share of the state population eligible for Medicaid grew from 13 percent to 35 percent. The Kaiser Foundation reports that in 2010, 32 more states expanded eligibility requirements. In 2001, New York adjusted its requirements so that the share of the state population eligible for Medicaid grew from 13 percent to 35 percent. For the time being, the program’s new enrollees have benefited. But states should be weary of making promises they can’t keep. At its peak, Tennessee’s program covered nearly a quarter of the state’s population. In 2004, McKinsey and Company evaluated the program’s viability. McKinsey reported that by 2008, the program would consume 36 percent of the state’s budget and that “its cost growth in that year will represent 91 percent of new state tax appropriations.” Tennessee’s Democratic governor, Phil Bredesen, called the report “sobering.” He scaled back the program, cutting 200,000 from the roles in just four months. Medicaid was designed to provide health care to the poor. And it should do that. But expanding coverage to higher income groups and childless adults makes it harder to fulfill Medicaid’s core mission. States looking to control costs are constrained by the perverse incentives of the federal matching formula. Former President Clinton’s budget director, Alice Rivlin, teamed up with Republican Representative Paul Ryan to suggest the funding formula be converted to a block grant. This seems an eminently sensible step. As a quarter million Tennesseans found out, unrealistic promises benefit no one — least of all those who come to believe in them.

Expanded Eligibility, Busted Budgets - Room for Debate - NYTimes.com

Then there is this article: A 'Budget-Busting' Law? | FactCheck.org

The nonpartisan Congressional Budget Office states that repealing the health care law would worsen the federal deficit over the next 10 years — by $230 billion.

So how does the House Republican Leadership support its claim that the law itself is "budget-busting" and would add $701 billion to the deficit? And how does Democratic Rep. Nancy Pelosi justify claiming it will "save taxpayers $1.3 trillion"? Both sides are spinning shamelessly.

We judge that CBO’s projection, which is both official and nonpartisan, is the best available. But even that estimate is uncertain, as the agency itself concedes. For one thing, there is doubt about whether all of the Medicare savings in the law will actually materialize. Those reductions are supposed to offset part of the law’s new spending, but they could put too great a burden on hospitals.

Pelosi’s $1.3 trillion claim is deceptive. She’s projecting CBO’s estimate 20 years into the future, something the agency says is an imprecise and uncertain calculation. Furthermore the law raises taxes to pay for much of its new spending, so saying it "saves taxpayers" anything is misleading. Her figure is actually a reduction in the projected federal deficit.

article continues

As for the GOP’s claim that "the bill would add over $700 billion in red ink over the next decade," we judge it to be mostly bogus. ■It rests largely on a claim that hundreds of billions of dollars in projected Medicare savings are being "double-counted." But CBO is simply not doing that. ■The GOP’s $700 billion figure also includes more than $200 billion for a permanent "doctor fix" to prevent a cut in Medicare payments to doctors. But that is not even a part of the new law, and many Republicans endorse the "doctor fix" anyway. ■The GOP claims the law will cost $115 billion to administer, but that isn’t true. CBO actually puts those costs at roughly $10 billion to $20 billion over the next 10 years. Analysis In our Jan. 7 article we showed how House Republicans are misrepresenting facts to support their claim that the new law is a "job-killer." We said the truth is that the law is expected to have only a small effect on employment, including fewer low-wage jobs but also more jobs in health care and the insurance industry. We promised then that we would address at a later date the GOP’s claim that the law is also "budget-busting." Here we go. The Official Score Let’s start with the official, nonpartisan analysis issued by the CBO on Jan. 6. The agency said repealing the new law would produce a large change in the deficit, but not in the direction Republicans claim. CBO said repeal would "likely" cause "an increase in the vicinity of $230 billion." That’s for the 10 years ending in 2021. It follows that leaving the law in place will reduce the deficit by $230 billion, according to CBO’s official scoring. There’s reason to believe that the $230 billion figure is too high — though it’s not the fault of the CBO. It’s because some provisions of the law may not end up being implemented. Some unknown portion of the claimed savings from Medicare may never materialize. The law calls for new restraints on the future growth of Medicare payments to hospitals, skilled nursing facilities, home health agencies and other non-physician providers. Richard Foster, the chief actuary for the Centers for Medicare & Medicaid Services, has estimated that these restraints alone would cover $575 billion of the law’s new spending over 10 years. (Foster’s figure is for the decade ending in 2019, and would be larger if it were adjusted to bring it in line with CBO’s 2021 figure.) But Foster wrote in a report last April that it "may be unrealistic" to assume that all the savings would actually be realized. That’s because Foster’s computer simulations suggest that roughly 15 percent of hospitals and other such providers would become unprofitable under the restraints. "Although this policy could be monitored over time to avoid such an outcome, changes would likely result in smaller actual savings than shown here for these provisions," Foster wrote. He noted that Congress had overridden similar restraints on Medicare payments to physicians (enacted in 1997) for each of the seven years prior to his report. Congress has continued to put off those doctor-payment cuts since then. So — should Congress in the future do for hospitals what it has consistently done for physicians — the law will result in less Medicare savings than currently projected. How much less, and whether or when that might happen, is impossible for us to predict. Dems Also Exaggerate This uncertainty in what may happen to provisions of the law in the future also casts doubt on the Democrats’ boast that the law reduces the deficit by $1.3 trillion. That’s the figure Rep. Nancy Pelosi used on Jan. 5, when she was passing the gavel to new Speaker John Boehner. Pelosi claimed the law "will save taxpayers $1.3 trillion." She extrapolated that number from the CBO’s analyses, but the agency didn’t actually use that specific figure. As we said, CBO estimated the law would reduce the deficit by $230 billion over the 2012-2021 time period. For the following decade, CBO was less concrete, saying that the law (coupled with the reconciliation legislation that was passed with it) would reduce the deficit by "a broad range around one-half percent of gross domestic product." The Democratic staff of the Ways and Means Committee calculated what 0.5 percent of the estimated gross domestic product would be over a second 10-year period, coming up with a 20-year total of more than $1.3 trillion. But CBO has couched its second-decade estimates in all kinds of language about the uncertainty of projecting budget effects that far into the future. In a March 2010 analysis, it said: “Those longer-term calculations reflect an assumption that the provisions of the reconciliation proposal and H.R. 3590 are enacted and remain unchanged throughout the next two decades, which is often not the case for major legislation.” Several provisions, in particular those Medicare payment reductions, “might be difficult to sustain over a long period of time,” CBO said. The bottom line: Only time will tell if those kinds of savings will materialize. “The long-term budgetary impact could be quite different if key provisions of the legislation were ultimately changed or not fully implemented,” CBO said. ‘Double-Counting’? Now for the Republican claims. In its report, "Obamacare, a Budget-Busting, Job-Killing Health Care Law," the GOP leadership relies on a partisan analysis by the House Budget Committee’s Republicans, and states that the law will add $701 billion to the deficit in its first decade. That analysis can be found on the Budget Committee’s website, where the committee lists several alleged "gimmicks" that it says Democrats have used. The biggest alleged "gimmick" in dollar terms is this: "Democrats claim they are extending solvency of Medicare by cutting $398 billion from the program, but they simultaneously claim that these savings will offset new subsidy programs." Republicans claim Democrats are "double-counting" that amount. But whatever spin Democrats may be using to promote their legislation, the fact is that the CBO is not double-counting this money. Even Republican Rep. Paul Ryan of Wisconsin, the new chairman of the Budget Committee, conceded that in an interview with the Washington Post’s public policy columnist Ezra Klein last year.

My opinion is that the states are in trouble on their social safety net expenditures (including education, unemployment, healthcare, etc.) and that pointing a finger at Medicaid is correct, but only to the extent that it is only a part of the safety net expenditures. Whether Obamacare will make this worse or not, it probably is not driving the current problem. We have simply promised too much to too many and then we have layered a huge bureaucratic burden on top of the desire to help the needy.

I do believe that the Federal government is the main here. That problem would of course include Obamacare. If we wish to federalize the social safety net -- so be it. The current practice of writing some legislation and providing some funding from the feds to the states does not work. Period. The federal rules cost more than the funding provides. We need to cut out some of the middlemen in this process.

[Sphere]

My opinion is that the states are in trouble on their social safety net expenditures (including education, unemployment, healthcare, etc.) and that pointing a finger at Medicaid is correct, but only to the extent that it is only a part of the safety net expenditures. Whether Obamacare will make this worse or not, it probably is not driving the current problem. We have simply promised too much to too many and then we have layered a huge bureaucratic burden on top of the desire to help the needy.

I do believe that the Federal government is the main here. That problem would of course include Obamacare. If we wish to federalize the social safety net -- so be it. The current practice of writing some legislation and providing some funding from the feds to the states does not work. Period. The federal rules cost more than the funding provides. We need to cut out some of the middlemen in this process.

I do agree Medicaid is a very bad program mainly because it is convoluted and spends a very large chunk of money on deciding who is poor enough to qualify and what medical expenses will be covered. Also, because it is 50% state money it doesn't even serve as an effective safety net for obvious reason that it gets underfunded in the poorer states that would benefit from it more.

However, I don't see how you can translate the same notions onto the current health reform bill. A big part of the bill is cutting Medicaid and using the funds to pay for the new progressive subsidizing of private plans for the working poor. I.e. try and get people off of Medicaid and instead give them partially subsidized health insurance based on their income. It is the conservative approach to healthcare reform, and although I would much more strongly prefer a single payer system which does roughly the same thing, it is better than the current methods used in Medicaid.

The other parts of the reform; the subsidized high risk pools and personal mandate, also have the effect of pushing more people into private insurance pools which in theory would reduce premiums overall. The insurance companies moaned a little bit about the new regulations mandating certain coverages (children under 25, pre-existing conditions, no max benefit limit etc.) but they know full well they are in for a boom when the mandate hits, which will more than pay for the losses from meeting those regulations. Which is why the health insurance lobby supported the reform.

Overall the healthcare reform bill is flawed, but points us in a better direction. It did not introduce much in the way of cost-curving measures, as the "don't pull the plug on Granny" campaign worked, and Obama settled for a lump sum from big pharma in exchange for not giving the Federal government the right to negotiate drug prices, for now.

But it does do one important thing, it starts to get everyone in the US paying for healthcare, and being part of a risk pool one way or another. The the US, both in the private and public sectors, spends an incredible amount of money on healthcare administration. Indeed we spend as much per person on administration as the British pay per person for the NHS as a whole. This is because there is a lot of money to be saved by by insurers, the government and hospitals in trying to cut costs by not serving people. Now that it is assumed that everyone is in, even though it isn't a more efficient single payer system, it should mean less money going to administration and more going to actual health expenses.

[Viking Prince]

First -- we ahve been paying for the healthcare prior to the reform bill. The problem with the reform bill is that it continues the process of partial federal funding coupled with federal rules and then leaving implementation to each state. This is also related to education. The Federal government has a cabinet post devoted to writing regulations and dispensing funds tied to the regulations. Yet the states are responsible for implementing the rules and more or less also the distributors of the funds. Obamacare does not correct this basic flaw but is massaging the Medicare savings calculation based upon the assumption that somehow more regulation will lower costs.

Also -- broadening the risk pool with low risk young adults and high risk exisiting conditions clients does nothing to help manage costs. The young adults (well the ones that are not hidden into the parental policies which is simply hiking costs of the parental policies) are included to help subsidize the older population and the high risk are included to hide the cost of coverage. It is a shell game at best -- add in the increased government regulations and it becomes a very expensive shell game.

[PoleCat]

...Also -- broadening the risk pool with low risk young adults and high risk exisiting conditions clients does nothing to help manage costs. The young adults (well the ones that are not hidden into the parental policies which is simply hiking costs of the parental policies) are included to help subsidize the older population and the high risk are included to hide the cost of coverage. It is a shell game at best -- add in the increased government regulations and it becomes a very expensive shell game.

I'd like some citation for this statement if you could. I can't see how broadening and deepening the existing risk pool won't have some benefit. I'd think that there are many more low-risk youth that can be added to the pool that would more than balance out the high-risk pre-existing condition additions. Have you seen something that leads you to think that these two groups are basically washing either out in the end?

Now as to whether it's a shell game - of course it is. But that's the sad fact when dispensing public funds - there are too many people clamoring for their handout and too many lobbyists involved. There are going to be winners and losers. We need to implement best measures while trying hard to keep those dollars used to maximum efficiency.

Is ObamaCare the best way to do it - I don't think so. But it is a framework to work within and at least it's a start. It's more than we had a few years ago. If the Republicans are smart they'll use their new leverage to strip the more useless measures, strip anti-trust protection from the health insurance companies, and then find a way to make insurance a fully portable commodity across the country instead of the 50 odd fiefdoms we have now. I'm not betting on the smart move though....

[Sphere]

Obamacare does not correct this basic flaw but is massaging the Medicare savings calculation based upon the assumption that somehow more regulation will lower costs.

There is a huge cut in Medicare payments in the bill, the article simply says that it is possible that Congress might choose to revoke them sometime in the future, as it has for past Medicare cuts.

The law calls for new restraints on the future growth of Medicare payments to hospitals, skilled nursing facilities, home health agencies and other non-physician providers. Richard Foster, the chief actuary for the Centers for Medicare & Medicaid Services, has estimated that these restraints alone would cover $575 billion of the law’s new spending over 10 years. (Foster’s figure is for the decade ending in 2019, and would be larger if it were adjusted to bring it in line with CBO’s 2021 figure.)

But Foster wrote in a report last April that it "may be unrealistic" to assume that all the savings would actually be realized. That’s because Foster’s computer simulations suggest that roughly 15 percent of hospitals and other such providers would become unprofitable under the restraints. "Although this policy could be monitored over time to avoid such an outcome, changes would likely result in smaller actual savings than shown here for these provisions," Foster wrote. He noted that Congress had overridden similar restraints on Medicare payments to physicians (enacted in 1997) for each of the seven years prior to his report. Congress has continued to put off those doctor-payment cuts since then.

So — should Congress in the future do for hospitals what it has consistently done for physicians — the law will result in less Medicare savings than currently projected. How much less, and whether or when that might happen, is impossible for us to predict.

Its not that the CBO was using optimistic math in terms of the Medicare cuts, just that it doesn't consider the possibility that congress later revokes the cuts or scales them down.

[Viking Prince]

The maths are optimistic, but that is not my point. The center of the problem is that Congress writes legislation to minimize the effect on the Federal budget by including a pile of mandates on any funds distributed to the states. Add to that the natural tendency of the federal bureaucracy to also add to the administrative burdens and you have a disaster awaiting each and every state government. The you have the administrative rules to mask costs by 'contolling' disbursements for medical services. Each and every step the government takes to improve the social safety net has to be paid for regardless if it is costed out by the CBO for federal costs or simply passed on to the states to handle.

[MathiasOfAthens]

I just think she is really a smart governor... I mean who would of thought that cutting 280,000 people who are poor from state healthcare would do any good. I mean those people are going to be living it up now... now they are free of the burdon of state health care and can finally afford to purchase their own private plan.

[Viking Prince]

I just think she is really a smart governor... I mean who would of thought that cutting 280,000 people who are poor from state healthcare would do any good. I mean those people are going to be living it up now... now they are free of the burdon of state health care and can finally afford to purchase their own private plan.

Well, without knowing the demographics of the people being cut from the rolls, I for one cannot say whether it is smart or not. I do think that if these are supposed to be state programs that the judgment should be a state and not a Federal issue.

[MathiasOfAthens]

State runs the Medicare program in the state as far as I know. Fact is these people wouldnt be on the lists if they could afford private healthcare.

[Sphere]

State runs the Medicare program in the state as far as I know. Fact is these people wouldnt be on the lists if they could afford private healthcare.

No, you are thinking of Medicaid i.e. paying for the poor/children. Medicare and most of the new subsidies in the reform are administered by the Federal Government directly.

[Viking Prince]

Making it a requirement that the youth must be carried by the policy of the parents until age 26 means that muct be priced into the policy. It is a net increase in costs because that pricing increase to family plans happens but the youths may be covered on other lower cost policies through employment, military, school, etc. In many cases this means double coverage since the other coverage is also a condition of the activity as well. For example, many schools require an insurance policy for attending to help defray the cost of on campus clinics or basic individual major medical coverage may be a benefit of employment. Also -- the overage of a parental policy may include many factors that are not important for a young adult when needing medicial insurance. Most young adults are concerned about major medical and not really desiring a medical package more suited for a family or for older adults. Once again, government likes one size fits all solutions and that mean the default position is to spend more money than required.

As to the high risk pools -- these costs are already within the system. Unless you believe that people are dropping because dialysis is not being delivered. Preexisting conditions are high cost chronic care in most cases. Many people will also demand expensive but unproven treatments when they believe another party must be picking up the tab. This is a problem with insurance generally, but why add more demands to the existing provision of services. Attaching such costs to insurance is a truly poor public option. The costs are for certain and known current care and not really insurance.

[PoleCat]

I agree that the provision to attach "Children" up to age 26 is one of the more idiotic of the bills provisions and should be stripped. But that is not the sole purpose of the bill - we can strip that out and improve the whole.

...As to the high risk pools -- these costs are already within the system. Unless you believe that people are dropping because dialysis is not being delivered. Preexisting conditions are high cost chronic care in most cases. Many people will also demand expensive but unproven treatments when they believe another party must be picking up the tab. This is a problem with insurance generally, but why add more demands to the existing provision of services. Attaching such costs to insurance is a truly poor public option. The costs are for certain and known current care and not really insurance.

But I will take exception to this statement. Not all pre-existing conditions are chronic or life-threatening. Not all are costly to treat either. The problem with the term is the definition made by the insurance companies based more on the numbers of bean counters than anyone with a medical degree. The way it's worked for so long is to work to insure only the healthiest of consumers - in reality health insurance is more catastrophe insurance rather than a program for insuring long-term health from the business POV. But that is what the consumer wants - a comprehensive package that covers all health related costs across the board.

Maybe if we remove the 50 different State regulations and incorporate one overarching Federal rule set we will see an improvement. But then we get into States Rights issues. It's not an easy fix but something must be done.

[motiv-8]

Making it a requirement that the youth must be carried by the policy of the parents until age 26 means that muct be priced into the policy.

I agree that the provision to attach "Children" up to age 26 is one of the more idiotic of the bills provisions and should be stripped.

Uhh, guys... It's not a requirement. It's an option. Providers have to offer it, but parents DON'T have to do it. I don't know how old you folks are or what your family statuses might be, but it saved my family money.

[Viking Prince]

I agree that the provision to attach "Children" up to age 26 is one of the more idiotic of the bills provisions and should be stripped. But that is not the sole purpose of the bill - we can strip that out and improve the whole.



But I will take exception to this statement. Not all pre-existing conditions are chronic or life-threatening. Not all are costly to treat either. The problem with the term is the definition made by the insurance companies based more on the numbers of bean counters than anyone with a medical degree. The way it's worked for so long is to work to insure only the healthiest of consumers - in reality health insurance is more catastrophe insurance rather than a program for insuring long-term health from the business POV. But that is what the consumer wants - a comprehensive package that covers all health related costs across the board.

Maybe if we remove the 50 different State regulations and incorporate one overarching Federal rule set we will see an improvement. But then we get into States Rights issues. It's not an easy fix but something must be done.

I did not state that all were. Also -- you seem to be mixing group and individual plans in your argument. The easiest solution to this mess is to repeal the whole law and then pass sensible legislation that can be agreed upon by many legislators from both parties. The cram down is now taking on a life of it's own. The regulatory jungle being set up with federal regulators is only going to get worse. Fixing the bill one problem at a time is not the solution. It affects not just the federal budget, but as this thread shows all of the state budgets are getting squeezed.

Uhh, guys... It's not a requirement. It's an option. Providers have to offer it, but parents DON'T have to do it. I don't know how old you folks are or what your family statuses might be, but it saved my family money.

What part of providers must provide makes it an option? Or are you only concerned with options for you and mandates for others is fine? As far as I can tell, if you have a family plan it must include the young adults. Most family plans are also regulated to not vary by the number of children in the family. Not really an aspect of the bill directly, but a direct consequence of the bill.

[PoleCat]

I did not state that all were. Also -- you seem to be mixing group and individual plans in your argument. The easiest solution to this mess is to repeal the whole law and then pass sensible legislation that can be agreed upon by many legislators from both parties. The cram down is now taking on a life of it's own. The regulatory jungle being set up with federal regulators is only going to get worse. Fixing the bill one problem at a time is not the solution. It affects not just the federal budget, but as this thread shows all of the state budgets are getting squeezed.

Actually I was mostly focusing on the individual plans. When talking about pre-existing conditions then we have to be talking about private plans as opposed to insurance through business.

I know you want to completely deregulate the industry. I say let's have one overarching regulation at the Federal level instead of the State patchwork we have now and allow for full portability of insurance between states. This at least builds some competition back into the industry. As it stands now there is next to none with all of the smaller companies slowly being swallowed by the behemoths.

[Kanaric]

Not even Rand Paul proposed cutting anything related to Medicaid in his recent fantasy cut bill (that ignores the defense budget of course).

Medicaid is going nowhere so if you want to see it cut dream on. I dont think politicians even care about medicaid at all but I guess Obamacare rings better than Bushcare so you really can't get anyone to rally against it or for reform.

Making it a requirement that the youth must be carried by the policy of the parents until age 26

I always thought this was the dumbest thing imaginable. Its as if the idea of "child" get continously older. When you are 26 you had better be on your own, you shouldn't still be considered a child and covered by policies created for children. Plenty of people are even through college by that point unless they seriously slacked or are in graduate school.

It would be nice if these mental health provision caught Tuscon shooters before they went killing people as well. What exactly does this mental health part of medicaid do? Diagnose kids with ADD and buy them their crack pills?

[B5C]

I always thought this was the dumbest thing imaginable. Its as if the idea of "child" get continously older. When you are 26 you had better be on your own, you shouldn't still be considered a child and covered by policies created for children. Plenty of people are even through college by that point unless they seriously slacked or are in graduate school.

If the US government covers this why not private? Tricare covered me until I was 24. As long i was still in college.

[Admiral Piett]

I bet if we had a public option plan in healthcare reform, we would be able to afford making significantly large cuts to both agencies. If not, get rid of Medicaid altogether.

[MathiasOfAthens]

I think before we get rid of Medicaid we should replace it with an equally suited program. Remember what Medicaid does...
http://en.wikipedia.org/wiki/Medicaid

Among the groups of people served by Medicaid are... including low-income adults and their children, and people with certain disabilities.

Think of the children...

[chilon]

So is this a sign that the recently passed health care reform (Obamacare) is doing more damage than good?...

I do believe that the Federal government is the main here. That problem would of course include Obamacare.

If you are going to use a bizarre derogatory slang term "Obamacare" could you please operationally define it?

I don't want a link to long blog somewhere just your own words in defining exactly what list of policy provisions defines "Obamacare". I see the word tossed around to describe "health care reform bill" but I am unsure what provisions in that bill constitute "Obamacare" since much of the "reform" was not really reform at all.

So do you consider every single specific provision such as expanding the drug coverage "donut hole" for fixed income senior citizens to be some nefarious portion of 'Obamacare'? Or are you only considering provisions such as provision that states that all individuals must purchase health care to be the defining provisions (which btw was something the HMOs really wanted in the bill)?

So what actual provisions define the odd term "Obamacare" for you?

PS. I personally really liked this quote, can't remember who said it "health care in America is actually very good, its the health insurance system that is utterly broken".