Category: MM Curator

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

[MM Curator Summary]: In which the opiner opines the unthinkable.

Clipped from: https://idahofreedom.org/an-idaho-without-medicaid/

Counterfactuals are hard to contemplate. What would the world be like if we never did X? Or, what if we had done Y, instead? In the classic movie, “It’s a Wonderful Life,” the main character, George Bailey, gets a glimpse of how his community would have fared had he never been born.  The experience is an eye-opener for him; it shows him his amazing influence and how he is a blessing to those around him. George learns the world is better with him in it than without him.

Is government medical welfare –  Medicaid — like George Bailey? Is Idaho’s world better with Medicaid in it? Let’s do a similar thought experiment. What would Idaho be like if we did not participate in Medicaid — one of the most expensive and least effective welfare programs ever devised? 

We must first recognize that programs (Medicaid) are costly, but people (George Bailey) are productive.  Most people produce more than they consume, while the government must feed off the productive sector to survive. The prosperity of a free people creates the capacity–and the incentives–for people to produce and then help their fellow man. The parasitic nature of government lacks the capacity on its own to promote the general welfare and therefore requires compulsory taxation. Thus, government programs, by their nature, are inferior to people.

The Idaho Freedom Foundation has extensively chronicled the beast and the burden that President Johnson’s Great Society program of Medicaid has become for Idaho.  As of 2023, 432,804 individuals are on Medicaid rolls, according to the Idaho Department of Health and Welfare, and the Legislature has appropriated a total Medicaid budget of nearly $4.68 billion for the coming fiscal year. We spend more than $10,000 per year for each person on Medicaid. Medicaid is enormous, with coverage exceeding 22% of Idaho’s population and consuming over 32% of government spending. The program  has been in place since 1966 and has done nothing to solve long-term poverty issues in the state.

No federal law  requires Idaho, or any state for that matter, to administer a Medicaid program. It’s completely optional. The last state to join Medicaid was Arizona, which did so in the 1980s. It’s clear that getting rid of the Medicaid behemoth would save the state (and the nation) billions of dollars from the start.  We will hear the cries immediately: “You don’t care about people, about kids. They will be dying in the streets for lack of health insurance assistance and the health care coming with it.” Is this a truly serious concern, though?

For a close comparison, The Washington Post reported in 2012 on how the U.S. might work without Medicare, a separate program for old age health insurance assistance.  Remember, the report spoke to the cost of medical insurance for seniors (Medicare), not for the poor (Medicaid).The Post report focused on two concerns. One was that medical care and insurance will become exceedingly expensive for those on fixed incomes. The other was that the elderly, more than other demographic groups,  need more health care because of their old age and its related health problems.   

The two concerns of seniors  — the cost for those on fixed incomes and the increased need for health care — don’t necessarily exist for many in the Medicaid population, who have more work opportunities and who have fewer health problems because of their younger age (and we could still manage to help the disabled and children without requiring the full Medicaid bureaucracy). 

Ending Medicaid is much less problematic than ending Medicare. Seniors do have more limitations on their ability to earn income, and they do have more health care needs. Top that with the fact that seniors have paid Medicare taxes their entire lives, and there are compelling philosophical problems with ending Medicare, at least as it applies to people who have been taxed for the program their whole lives. Some seniors do receive indigent support through Medicaid now (about 27,000), but ending Medicaid could include other options for them such as a more robust Medicare system for long term care and/or more family and community care responsibilities for their well-being.  In short, there are far fewer obstacles to ending Medicaid.

Prior to 1965, and the advent of state-run health insurance for the poor, medical insurance and care came largely from state policies via public assistance but more directly from communities and churches. There is scant evidence of “people dying in the streets for lack of health insurance or healthcare.” Quite the opposite, America has a history of being one of the most charitable countries on the planet.

According to the Charities Aid Foundation annual report,
World Giving Index 2022, the U.S. is the third most charitable country overall. We are in the top ten of all countries in the report’s three main measures of charity: helping a stranger, donating money, and volunteering time.  Imagine the charitable waterfalls that would be created if billions of dollars in Idaho were returned to individuals (from government) stoking their proclivities to help others. Churches, medical centers, communities, families, and individual benefactors would be better equipped to exercise their generosity and caring for others. Those private entities existed before Medicaid came into being. Where are they now? 

Let’s not forget how government “caring” often crowds out private charity. Knowing a government program exists, can make us complacent in helping others. We don’t leave our friends and neighbors to die in the streets. Instead we respond to incentives and to what our resources limit us to. Many of us will probably be more willing and ready to help when we know there isn’t a government safety net — in other words, when the caring responsibilities fall on us rather than a government program. 

We can only imagine the love, care and  personal sacrifice that would come when the charity falls to the private sector. Health foundations, community care centers, and church affiliated programs already exist. There is human dignity in helping others through voluntary donations and time sacrifice. Those virtues are squelched  when government bureaucracies commandeer our private responsibilities, but they are magnified when people are free to rise  to the occasion.

It’s not hard to imagine the true good for Idaho families that would come from ending or severely cutting the broken Medicaid system. Families could keep more of their tax dollars, shop for the best private insurance and health care, and see lower health care costs. Free from the state burden of Medicaid, Idaho could reduce taxes by more than  $1 billion per year.  Carefully crafted, that might mean cutting all Idaho property taxes or individual income taxes in half, permanently.It could mean ending corporate income taxes. Or cutting sales taxes as well as eliminating the sales tax on groceries.

With such a boost in disposable income, combined with more economic freedom, families could be more charitable toward their communities and each other in providing personal assistance. In all this, government in Idaho would be limited to its proper role.  And, restoring the competitive, private health insurance market will lead to lower costs and better service than the insulated, monopolized, government insurance program. 

Those searching for the best healthcare alternatives won’t be shunted into government cookie-cutter programs ill suited-for innovation and choice. Reverting to private health insurance and healthcare, individuals are sure to have more options and more freedom than they would under federal/state health insurance programs. 

The Idaho Freedom Foundation sees virtue in private action, in human caring, and in the liberty and dignity coming from personal sacrifice. Impersonal and coercive government programs and bureaus cannot develop virtue, and a government bureau is a poor and expensive substitute for the personal touch of friends caring for friends. The world needs more George Bailey and less Medicaid.  Let’s give liberty and love a try for a change.

Ronald M. Nate, senior policy fellow at the Idaho Freedom Foundation, is an economics professor at BYU-Idaho, holds a Ph.D. in economics from the University of Connecticut, and is a former state representative for Idaho Legislative District 34.
Ph. 208-403-3609

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

[MM Curator Summary]: In which the heretic says the heretical.

Clipped from: https://www.independent.org/news/article.asp?id=14586

What does Texas understand that other states don’t?

With the recent addition of North Carolina and South Dakota, 40 states have now opted to expand Medicaid coverage. Texas legislators ignored the lure of “easy money” from Washington and nixed the idea again. Who’s right?

Texas Medical Association lobbyists told state legislators that expanding Medicaid eligibility would reduce the number of uninsured by half, producing $5.4 billion a year in federal matching funds in exchange for $650 million a year in new state spending.

It’s the same bill of goods that lobbyists in other states used to pitch Medicaid expansion. But the numbers don’t add up.

According to calculations by the Foundation for Government Accountability, expansion states forecast that their total Medicaid enrollment would increase by about 6.5 million. As of 2022, the actual increase stood at 16.7 million.

Medicaid costs have also significantly exceeded forecasts. In 2012, the Department of Health and Human Services predicted annual costs would average $4,000 per person. By 2018, the actual costs were 50% higher: $6,100 per person.

Medicaid expansion, encouraged by the Affordable Care Act, has helped reduce the percentage of uninsured, lowering it from 17.8% in 2010 to 10.9% by 2019. But supply didn’t rise to meet the increased demand.

Instead, the overall number of annual physician visits decreased from an average of 332 per 100 people in 2010 to 276 per 100 in 2018.

The small uptick in physician visits among low-income patients was offset by small reductions among the rest of the population.

Expanding Medicaid to the relatively healthy might make sense if it improved general health. But there is little evidence it does. In Oregon, for example, a first-of-its-kind controlled trial tracked individuals who applied for Medicaid through a lottery.

After two years, there was no discernible difference in the health of coverage winners and losers.

Health outcomes aside, the Texas medical establishment apparently was hoping the added $5.4 billion in Medicaid matching payments from Washington would improve the bottom line. That was wishful thinking.

Medicaid reimbursement rates are generally lower than both commercial insurance payments and total provider costs.

Research shows that lower-income working-age people often substitute Medicaid for existing private coverage, which typically requires out-of-pocket cash payments for co-pays and deductibles. This reduces providers’ overall compensation.

Below-cost payments may be manageable when Medicaid covers a relatively small portion of the population, but when Medicaid replaces private payers for large portions of the population, the combination of below-cost payments, reduced commercial insurance payments, and increased regulatory costs, invariably exceeds the savings providers realize from providing less uncompensated care.

A 2020 analysis of IRS filings for 2,253 nonprofit hospitals in expansion and nonexpansion states confirms this. The analysis showed that Medicaid expansion reduced reported uncompensated-care costs by an average of $1.11 million between 2012 and 2016.

But it also increased average losses, largely due to reduced income from commercial insurance and below-cost Medicaid reimbursements, by $1.63 million.

For Texas lawmakers, the fight over Medicaid expansion couldn’t have come at a more opportune time: As state health care providers were grappling with the extraordinary staffing and financial burdens caused by the federal government’s unprecedented tolerance of illegal immigration.

This certainly helped focus their attention, as did the testimony of Dr. Robert Trenschel, president and CEO of Arizona’s Yuma Regional Medical Center, who told Congress earlier this year that providing uncompensated care for migrants cost his hospital $26 million in 2022 (helping to produce an operating loss of $14.2 million, according to HMP Metrics.)

The influx of migrants also has been “crowding out Yuma’s residents, competing for beds in the emergency room or forcing delays in elective surgery,” according to news reports. Complicating the problem are persistent staffing shortages. Staff, not physical beds, is the binding constraint for most hospitals. Yuma Regional is licensed for 406 beds, but at the pay rates it can afford, it usually staffs only 250 to 270 beds.

Texas border hospitals face similar problems. Medicaid expansion would have only exacerbated them.

To their credit, Texas lawmakers saw through the false economics of Medicaid expansion.

Even if expanding eligibility cost “only” $650 million per year, they understood that the same $650 million could be used to defray some of the costs imposed on hospitals, physician practices, and Texas citizens by the unprecedented level of immigration.

Or it could be used to improve care for those already covered by Medicaid. Some 114,000 developmentally and intellectually disabled Texans enrolled in Texas Medicaid have spent years on waiting lists for home- and community-based care they were promised but never received.

Shouldn’t public money be used to meet existing needs such as these before it’s spent on new benefits for healthy, able-bodied adults?

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

[MM Curator Summary]: Yes, Medicaid bennies – you can still sue when providers do wrong stuff. Thanks, SCOTUS!

Clipped from: https://www.medpagetoday.com/opinion/the-health-docket/105062

— An important accountability measure has been upheld

Andrew J. Twinamatsiko, JD, is an expert in health law and policy. Lawrence O. Gostin, JD, is a leading figure in national and global health law.

The Supreme Court’s decision in Health and Hospital Corporation v. Talevski , holding that beneficiaries of government entitlements can bring civil rights actions to vindicate their rights, is a major victory for millions of Americans who rely on publicly funded healthcare programs.

The justices refused to upend decades of precedent and allowed a nursing home resident’s family to sue an Indiana care home for abusing the resident. Talevski both vindicates the rights of vulnerable citizens and holds officials accountable. It affirms that Medicaid beneficiaries — some of the nation’s most vulnerable and politically powerless members — have a right to dignified care, while empowering them to sue government officials if their rights are not respected. With the recent uptick in state efforts to cut Medicaid, Talevski is a welcome assurance that the courts will remain available as a check on unfair and harmful state policies.

The Details of the Case

The case arose when Gorgi Talevski, a dementia patient at a nursing home owned by Health and Hospital Corporation of Marion County (HHC), suffered multiple abuses. HHC chemically restrained him using strong psychotropic drugs, sent him to a psychiatric facility without consulting his family, and subsequently arbitrarily discharged him. The Indiana State Department of Health failed to remedy the situation.

Talevski’s family brought a private lawsuit under 42 U.S. Code §1983opens in a new tab or window (Section 1983), a law enacted in 1871 that grants individuals the right to sue government officials and others acting “under color of state law” for civil rights violations. Section 1983 does not provide civil rights; it is a means to enforce civil rights that already exist, including Medicaid entitlements. Section 1983’s private right of action is a longstanding and important public accountability mechanism.

Talevski’s ordeal is not surprising. Abuses in nursing homes are commonopens in a new tab or window. Indeed, Congress enacted the Federal Nursing Home Reform Act (FNHRA) in 1987 to address the widespread abuse of residents. FNHRA establishes standards and oversight of nursing homes, including a residents’ bill of rights. FNHRA explicitly states that residents have a right to be free from physical and chemical restraints, and prohibits arbitrary discharge of residents.

Surprisingly, the Supreme Court agreed to hear this case even though there is longstanding precedent for bringing Section 1983 claims and there was unanimity among the circuit courts on the issue. Stakeholders were concerned that a conservative supermajority would use the case to overrule decades of precedent and undermine Medicaid.

Justice Ketanji Brown Jackson, writing for the Court, held that FNHRA unambiguously creates rights that can be vindicated using Section 1983. Jackson noted FNHRA uses “rights-creating language” that explicitly describes freedom from use of unnecessary restraints and the pre-discharge notice requirements as rights to which residents are entitled. What’s more, FNHRA requires nursing homes to respect residents’ rights, which are enforceable by individual residents. The Court rejected HHC’s argument that Congress cannot create rights enforceable under Section 1983 using its spending power, describing HHC’s arguments as “perplexing,” and grounded in “ambiguous historical evidence.”

In his dissent, Justice Clarence Thomas cited federalism concerns that suffused the Court’s reasoning in Dobbs v. Jacksonopens in a new tab or window — ending the right to an abortion — and NFIB v. Sebeliusopens in a new tab or window — striking down the Affordable Care Act’s (ACA) Medicaid expansion requirement — to argue that Spending Clause programs do not grant individual rights. Thus, Thomas would overrule the Court’s established precedents that have governed enforcement of government programs for half a century. Overruling precedent would severely curtail not only Medicaid but also a host of much needed entitlement programs such as the Children’s Health Insurance Program (CHIP), Temporary Assistance for Needy Families (TANF), and the Supplemental Nutrition Assistance Program (SNAP). Curtailing these programs would severely affect marginalized and underserved communities who already bear health burdens at a disproportionately higher rate, and thus exacerbate health disparities.

Health Implications and Takeaways

The Talevski decision is a significant victory for Medicaid beneficiaries as it keeps open the courts’ doors for vindication of federally conferred rights. The Medicaid program is vast, benefiting about 1.7 millionopens in a new tab or window nursing home residents. With at least 15,000 nursing homes across the nation, it is very difficult for the federal and state governments to maintain meaningful oversight to ensure that vulnerable members of society are receiving high quality, dignified care. The only enforcement tool the federal government has for Medicaid violations is to withhold funding, which rarely occurs.

By rebuffing HHC’s “attempts to sow renewed doubts about Section 1983’s” availability to enforce rights under the Spending Clause, the Court preserved an important accountability arrow in the Medicaid quiver. The Court’s rejection of a limited interpretation of the Spending Clause affirms a long-held principle that Medicaid benefits and other entitlements are rights, not privileges that states can take away willy-nilly. Enforcing these rights under Section 1983 gives individuals not only access to the courts but also a suite of remedies, such as injunctions, damages, and attorneys’ fees.

From a health equity standpoint — especially considering the continued worsening of health disparitiesopens in a new tab or window during the COVID-19 pandemic and states moving to purgeopens in a new tab or window their Medicaid rollsopens in a new tab or window — the Talevski decision preserves the important role Medicaid plays in closing health gaps. Since its enactment in 1965, Medicaid has been an indispensable source of access to healthcare for millions of Americansopens in a new tab or window. With the expansion of Medicaid under the ACA, Medicaid’s roleopens in a new tab or window in addressing health disparities cannot be overstated. Various vulnerable groups, comprising a disproportionate number of racial and ethnic minoritiesopens in a new tab or window, rely on Medicaid for their medical needsopens in a new tab or window, such as early screening and preventive services, family planning, inpatient and outpatient hospital care, prescription drugs, and extended institutional care for the elderly.

While the Talevski case centered around only two rights for nursing home residents, the Supreme Court’s ruling broadly encompasses a multitude of rights and welfare programs. In assuring that vulnerable individuals may rely on Section 1983, the Talevski decision will go a long way to preserve people’s rights to timely enrollment, comprehensive coverage, and eligibility determination.

Andrew Twinamatsiko, JD,opens in a new tab or window is an associate director of the Health Policy and the Law Initiative at the O’Neill Institute. Lawrence O. Gostin, JD,opens in a new tab or window is University Professor, Georgetown University’s highest academic rank, where he directs the O’Neill Institute for National & Global Health Law. He is also director of the World Health Organization Collaborating Center on National & Global Health Law. He is the author of the book, Global Health Security: A Blueprint for the Futureopens in a new tab or window.

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

[MM Curator Summary]: BlueGrass Nursing Homes will get $13M more for services already delivered in 2023 under lower rates; AND will get $100M for services in the next FY under the new rates. Where do I sign up for this deal?

Clipped from: https://www.somerset-kentucky.com/kentucky/beshear-increases-medicaid-reimbursement-rates-for-home-and-community-based-services-and-long-term-care/article_c7e7bbb4-0ac7-11ee-a55f-af46e0f6dfbf.html

Kentucky Governor Andy Beshear sits for an interview in Versailles, Ky., Wednesday, May 17, 2023.

AP Photo/Timothy D. Easley

Gov. Andy Beshear has raised Medicaid reimbursement rates for home and community-based services and long-term-care facilities to help them deal with inflation, workforce shortages and the effects of Covid-19.

“We have a duty to make sure those who need in-home care, community-based care and long-term care get the services they need and the services they deserve,” Beshear said at his weekly news conference Thursday. “This increase will provide some interim financial relief for organizations that take care of our parents and our grandparents. And right now they need our help, and we need to be there for them.”

Most of the money for the increase will come from the federal government, which funds about 70 percent of traditional Medicaid spending. The state share “is able to fit within our current appropriated budget without the need for additional state funds,” said Susan Dunlap, spokeswoman for the Cabinet for Health and Family Services. “The current Medicaid spending trends allow the cabinet access to funds to increase the Medicaid rate.”

Dunlap noted that the cabinet “is required to adjust price-based nursing facility rates for inflation every July 1. During the budget process, the cabinet accounts for an inflationary increase in our projections for the inflationary adjustment.”

The nursing-home adjustments are retroactive, to make up for underestimated inflationary increases that were provided in the last three years, Beshear said. This will result in $99.6 million more for nursing homes in the next fiscal year, which ends June 30, 2024. The state’s share will be $18.9 million.

The adjustment for home and community-based services will be for services that were delivered from Jan. 1, 2022, to May 1, 2023, at an additional cost of $13 million, according to a news release.

The main lobbying group for nursing homes and assisted-living facilities told Kentucky Health News that it is expecting an overall adjustment of about 8 percent, and that it will vary from facility to facility.

Betsy Johnson, president of the Kentucky Association of Health Care Facilities and Kentucky Center for Assisted Living, praised the governor’s action, calling it “welcome relief” for struggling long-term care facilities that have been sounding the alarm about the skyrocketing costs required to keep their residents and patients safe and healthy.

“We are grateful for Gov. Beshear and his administration,” Johnson said. “The pandemic had devastating effects and worsened the staffing crisis we were already facing. This funding will be paramount to providing quality care to residents and patients as well as building the foundation for a brighter future.”

John Muller, chief operating officer for Carespring Healthcare Management in Northern Kentucky, thanked Beshear and his team at the news conference. Muller is also a KAHCF board member.

“Nursing facilities were on the front lines of the Covid pandemic. The last number of years have been very, very difficult,” Muller said. “And as we are coming out of the pandemic, the aftershock is the workforce challenges that we’re facing. Nursing facilities are lagging far behind on catching up in the workforce. These much-needed funds will go a long way for the residents we serve . . . as well as the team members we need to retain and the new ones we need to recruit.”

David McKenzie, administrator and owner of The Jordan Center in Louisa, conveyed an urgent need for these increased funds in a letter to Health and Family Services Secretary Eric Friedlander on March 28,

McKenzie painted a picture of his facility’s dire financial situation and asked for a “funding bridge” to allow nursing homes to survive until July 1, 2024, when their rates are scheduled to be recalculated.

“Our facility will not make it if we don’t receive a funding bridge July 1, 2023,” he wrote. “We have never seen price increases like this in our 49 years of business! In February 2022, we had to close half of our facility because we only had enough staff to operate 60 beds and maintain our 5-star staffing rating.”

Emily Webber, KAHCF director of communications, said the additional funding will go a long way to help pay for supplies, operational costs and staffing, noting that long-term care facilities are still one of the health-care sectors that have not recovered from the staffing shortages caused by the pandemic.

Beshear has also committed to rebasing the Medicaid rate effective July 1, 2024, but that would require appropriations from the General Assembly next year, and Beshear’s term will end late this year unless the voters given him a second four-year term in the Nov. 7 election.

“We’re dealing with an election. We’re dealing with a budget session. So there are lots of things for us to address,” Johnson said. “But as you just stated, right now, where it stands, we understand that the current administration and the Kentucky legislature are very sympathetic to our challenges and we believe that we can all work together so that this money will be appropriated.”

Johnson said her members are “thrilled” because they have not seen a Medicaid raise since 2008 and are now operating in a completely different world.

“This funding is a good first step toward getting us back on our feet,” she said, adding later, “If you ask any one of our member providers, when we say, ‘Oh, post-pandemic world or post-Covid,’ they will look you in the eye and say, ‘Betsy, we’re still in it’ because the struggles are real. It has forever changed the way they operate and the staff that they need. It’s very, very important that we should all, as Kentuckians, be invested in this taking care of our elderly, and our most vulnerable citizens.”