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Valued Social Butterfly
Posts: 991
Registered: ‎01-02-2012

Re: Medicaid Retroaction being rolled back in some states

Message 21 of 27 (121 Views)

umbarch64 wrote:
 

I'm talking about universal basic health care for every citizen...pre-natal to giving up the ghost. Shoot...I'll even throw in cremation, doesn't cost much anyway and gets rid of a nuisance nobody wants hanging around.  So... everything goes back to where it came from....

 

No one I know of has honestly calculated the savings to be had from a single payer 'not for profit' health care system.  The savings from redundant overhead and capital improvements in the insurance component alone is so large it may well fund the increased benefits package with a surplus that could be applied to the National Debt.  IF you think not, you probably also think all the 'for profit' players operate at a deficit and will go out of business soon. 

 

By itself a single payer system, responsible to the citizen alone, could and probably would be far cheaper than an equivalent package offered by the 'for profit industry' simply because there would be no redundancy.  Profit, if any, would go to the people performing the services, not to bean counters and lobbyists.  Operation simplicity would reduce corruption-scams-fraud-etc. and eliminate an entire bureaucracy now needed to detect, regulate, enforce and prosecute....all that. Yeah....some folks would actually have to go back to work instead of playing the stocks.  Their old 'job' would be gone....at least in the health care sector.  

 

Maybe I just understood something more clearly.  Folks like the posters below may not like a single payer health care system, because they've become dependent on the 'for profit' system we now have.  Hmmmm.  Could be the dependency they're so fond of using for a scapegoat has two faces...at least.   


umbarch

 

Gail answered you from one perspective. Let me give you another that is not opposed to Gail's perspective but just looks at the issue from a different dimension.

 

Where I live (Massachusetts) we basically have almost-100%-non-profit, "universal health care" (and not just universal basic health care, your words, if "basic" is an important part of your description). We have had it for over 100 years. No one -- other than because of some undiagnosed cognitive issue -- dies from lack of health care in Massachusetts or has to worry about paying for it. That has been the case for 40 years.

 

That's because, for 40 years, the state government has taxed all hospitalizations and healthcare insurance so as to guarantee that it will be the payer of last resort for all hospitalizations. In addition, it used those taxes (and I think some Federal funds that date to a JFK-era law) to set up more that 40 very good quality "free care" community health centers (CHCs) around the state.

 

The state is geographically small so that the CHCs are all easily accessed except for a few towns in the hills -- we call them mountains -- in the northwest part of the state and on the far end of a sandbar in the southeast part of the state, that some people call Cape Cod. Even in these cases, there is never more than a 20 mile or so drive to top quality health care. In the area where most of the people live, the quality of the health care facilities is rated among the best in the world. In fact, health care is our most important industry -- we're demographically old -- and even is becoming a major export. 

 

To be clear, although it has been unversal for more than 100 years and no one has had any concerns about paying for it for 40 years, its financing is not single payer. But being such a liberal state, our totally one-leftist-party government has looked at the economics of single payer every year since around 1985 -- study after study after study from the the nobby heads at Havard and other elite academic outposts. The economics you think might be there are not, partially because almost the whole system is already non-profit and partially because all the administrivia does not go away, despite a few outlier studies from an organization called National Doctors Against Insurance Companies, or some such long name, that no one else can duplicate.

 

The simple fact is -- take it from the center of the discussion -- good quality health care is expensive. But it's good.

Valued Social Butterfly
Posts: 8,793
Registered: ‎08-18-2008

Re: Medicaid Retroaction being rolled back in some states

[ Edited ]
Message 22 of 27 (120 Views)

What in the world are you whaling about ,umbarch64

 

We are talking about MEDICAID here - the healthcare coverage for the poor - whatever way your state describes it - 100% of the FPL, 138% or 300% - 400% of the FPL, well, at least for certain populations - certainly not poor seniors that need lots of help.

 

No lobbyist, no private insurance just (2) levels of the government overseeing it and trying not to go too far over budget - duking it out between each other, so to speak.

 

What is so hard about asking people to sign up for whatever coverage they are eligible?  Including the poor.

 

And as byrondennis said, in Mass. In their Safety Net program, they cover not only the UNinsured poor, by their definition, but also even help out the UNDERInsured.

 

IF we ever go the single payer route, these would be the same arms of government setting it up and yes, a single payer system does have a lot of complexities.

 

So should we, under state guidelines, retroactively pay the healthcare bills of those who are Medicaid eligible and haven't even bothered to sign up?  Talk about waiting until you get sick to get coverage -

 

 

 

 

 

Valued Social Butterfly
Posts: 1,673
Registered: ‎02-12-2011

Re: Medicaid Retroaction being rolled back in some states

[ Edited ]
Message 23 of 27 (129 Views)

Does no one understand that complexity like this is incredibly expensive to the citizens footing the bill?  One way or another, the citizen pays for all of it. The 'Industry' doesn't.  The citizen even pays for the inevitable corruption that is in lock-step with every added complexity.  That wad I'm talking about would choke an elephant...but doesn't seem to.  Could be they feed off it.  [pun intended.]

 

Fact is these posters step right around the most efficient and effective way possible to do this so the citizen ends up paying the least.  They do it without even looking down to see who it is they stepped on. That's not conscionable, so I've got to conclude they just don't care.

 

I'm talking about universal basic health care for every citizen...pre-natal to giving up the ghost. Shoot...I'll even throw in cremation, doesn't cost much anyway and gets rid of a nuisance nobody wants hanging around.  So... everything goes back to where it came from....An Ouroboros that really does survive what it does to itself....'cause it has outside help, donchasee? 

 

No one I know of has honestly calculated the savings to be had from a single payer 'not for profit' health care system.  The savings from redundant overhead and capital improvements in the insurance component alone is so large it may well fund the increased benefits package with a surplus that could be applied to the National Debt.  IF you think not, you probably also think all the 'for profit' players operate at a deficit and will go out of business soon. 

 

By itself a single payer system, responsible to the citizen alone, could and probably would be far cheaper than an equivalent package offered by the 'for profit industry' simply because there would be no redundancy.  Profit, if any, would go to the people performing the services, not to bean counters and lobbyists.  Operation simplicity would reduce corruption-scams-fraud-etc. and eliminate an entire bureaucracy now needed to detect, regulate, enforce and prosecute....all that. Yeah....some folks would actually have to go back to work instead of playing the stocks.  Their old 'job' would be gone....at least in the health care sector.  

 

Maybe I just understood something more clearly.  Folks like the posters below may not like a single payer health care system, because they've become dependent on the 'for profit' system we now have.  Hmmmm.  Could be the dependency they're so fond of using for a scapegoat has two faces...at least.   

Valued Social Butterfly
Posts: 991
Registered: ‎01-02-2012

Re: Medicaid Retroaction being rolled back in some states

[ Edited ]
Message 24 of 27 (150 Views)

GailL1 wrote:

 

I actually thought if a state expanded their Medicaid program that the 1115 Medicaid waiver for these uncompensated care pools was taken away.

Are you sure it is still going on in Mass?

 

Family USA - May 2015 - Explainer: Medicaid Uncompensated Care Pools

 

Hasn't it been morphed into somethin else?

Mass.gov - 1115 Waiver Proposal Information

 


Do you mean is  the "free care pool" still "going on in Mass?" If so, the answer is yes. You will notice in one of your links:

 

  • "MassHealth requests to continue currently authorized funding for uncompensated care, including the Health Safety Net, and to continue the current Public Hospital Transformation and Incentive Initiatives."

 

Our current 1115 waiver, which is about the sixth we have received since about 1998, was approved a few weeks before Obama left office and is effective through 2022 (thanks everyone in the rest of America).

 

The so-called Explainer in another of your links does not really explain how the Massachusetts Health Safety Net (HSN) works; see my link instead and the state's report on how the program worked for this year (most recent report; new report due out in a month); how the tax changed this year is in my link above.

 

Massachusetts did not really expand its Medicaid under Obamacare.

  • We already had expanded it years ago based on a 1115 back in the late 1990s. This is just another reason why the comparisons of RomneyCare and Obamacare back in 2009 and 2010 never made any sense. Almost everything in Obamacare that supposedly came from Romneycare had been Massachusetts state law long before RomneyCare (e.g., no pre-existing conditions, expanded Medicaid, guaranteed issue, universal care through the HSN, etc.).
  • The only thing that was really new from a national perspective (see Note) in RomneyCare was a tax if you did not buy insurance but could (what is called the individual mandate in Obamacare). However that was a joke since everyone that could buy insurance already did. And everyone that wanted a waiver could get it (there was a school teacher making $90,000 a year who applied as a joke and received a waiver).
  • What happened with Obamacare in Massachusetts (and this is may be why you are thinking something changed) is that under RomneyCare, many people on the HSN and our already expanded Medicaid pre 2006 were put into the exchange (in other words, they got insurance rather than welfare; the money went to the insurance companies first before going to the hospitals and CHCs).
  • Then with Obamacare, it was a better deal (because of the 90% funding for newbies) to take them out of the exchange and put them back on Medicaid. About 200,000 people have been see-sawed back and forth like this for more than a decade. That money was then used to give people still on the exchanges much better insurance than vanialla Obamacare (and some of that even came from the Feds as CSRs--until last month)
  • When you combine that 90% game and the CSRs with the Nantucket Cottage rule, Massachusetts made out very well with Obamacare.

NOTE: The other thing that RomneyCare did but had no meaning nationally is that it combined our individual and small business markets. This of course lowered insurance rates for individuals and raised them for small businesses. I was actually saved from this increase by turning 65 right on time because I had previously had (still do) a small business. That was the only thing good about turing 65 Smiley Happy

Valued Social Butterfly
Posts: 8,793
Registered: ‎08-18-2008

Re: Medicaid Retroaction being rolled back in some states

[ Edited ]
Message 25 of 27 (149 Views)

Well, wow - bryondennis - no wonder health care cost are so high in Mass - must be all those taxes on providers that just get past along to paying health consumers.

 

But regardless, since the ACA is the law of the land, even these folks should sign up for coverage of whatever type they qualify.  I am sure those Community Health Centers could do as much good treating those with Medicaid that those who are within this Uncompensated Care Pool or now known as the Safety Net Care Pool.

 

Guess it could cover some of those who legally cannot be insured, unless they have a job with coverage through their employer - like those here illegally.

 

I actually thought if a state expanded their Medicaid program that the 1115 Medicaid waiver for these uncompensated care pools was taken away.

Are you sure it is still going on in Mass?

 

Family USA - May 2015 - Explainer: Medicaid Uncompensated Care Pools

 

Hasn't it been morphed into somethin else?

Mass.gov - 1115 Waiver Proposal Information

 

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Valued Social Butterfly
Posts: 991
Registered: ‎01-02-2012

Re: Medicaid Retroaction being rolled back in some states

Message 26 of 27 (160 Views)

GailL1 wrote:

People should get covered and stay covered - it is important.  Medicaid is just another form or insurance so they need to get covered - but I bet many of them think they don't have to make application - they just get it when they need it - seems that is changing in some states.  If the savings is as great as indicated - this could spread to other states.

 

Isn't health care coverage important to everybody??  If you make application on the state or federal exchange - if you qualify for Medicaid and the state has expanded its program - they send you there.  It is an annual enrollment just like private individual coverage enrollment.

 

So these are folks that haven't bothered to do anything as far as signing up for anything in their state.  Evidently health care coverage is not important to them.

 

. . . . . in most states if you qualify for Medicaid — but weren’t enrolled at the time — the program will pay your medical bills going back three months. It protects hospitals, too, from having to absorb the costs of caring for these patients.

 

But a growing number of states are rescinding this benefit known as “retroactive eligibility.”

All four states — Iowa, Arkansas, Indiana, New Hampshire have expanded Medicaid under the health law.  So, in theory, most adults are required to have insurance under the ACA. In practice, each state still has a significant number of uninsured, ranging from 5 to 8 percent of the population.

 

The retroactive coverage “can compensate for the sorts of errors and lapses that can so easily occur on the part of both the applicant and the government bureaucracy” that delay applications, said Gordon Bonnyman, staff attorney at the Tennessee Justice Center, a public interest law firm that represents low-income and uninsured residents.

 

State and federal officials say eliminating the retroactive coverage helps encourage people to sign up for and maintain coverage when they’re healthy rather than waiting until they’re sick to enroll. It also fits into federal officials’ efforts to make Medicaid, the federal-state program that provides health care for low-income adults and children, more like private insurance.

But consumer advocates and health care providers say the shift will saddle patients with hefty medical bills and leave hospitals to absorb more uncompensated care when patients can’t pay. Some worry this could be the start of a trend.

 

In Iowa, the change applies to just about anyone coming into Medicaid — except for pregnant women and children under age 1. The change will affect up to 40,000 residents annually and save the program more than $ 36 million a year.

 

more at the link ~

KHN - 11/14/2017 - Some States Roll Back ‘Retroactive Medicaid,’ A Buffer For The Poor — And For Hos...

 


This issue is handled in Massachusetts -- and I suspect a few other Northeast states -- by what used to be called the "free care pool." Like its sister term, the "poor farm," we don't call it the "free care pool" anymore... politically incorrect maybe or sending too obvious a wrong signal maybe. Whichever, the name was changed to the Health Safety Net by RomneyCare.

 

But the real story of the "free care pool"/Health Safety Net in Massachusetts is that it -- not RomneyCare -- is the secret behind Massachusetts' historically low, country-leading uninsured rate. And it dates back to at least the 1980s in Massachusetts, maybe further. To take advantage of it (other than getting free hospitalization), you have to go to one of the 44 community health centers (CHCs) funded by it. People would rather go to one of the world class health centers (see Note) here so they get insurance and always have at a very high rate.

 

So when Obama/Gruber/Pelosi/Reid/etc. based Obamacare on Romneycare on the idea that Obamacare would reduce the uninsured rate because RomneyCare did, they built the system on a foundation that was not there; there is no national free care pool. Of course, Obamacare -- and Romneycare -- also dramactically increased the percentage of people eligible for Medicaid by just changing its rules. But RomneyCare did it with some of the "free care pool" money (and with handouts from the Federal government). Obamacare did not have a free care pool to borrow from (and of course it really couldn't give itself money -- hence the accounting tricks with the Medicare trust funds).

 

In Massachusetts, the free care pool is funded by taxes on all hospital admissions and health insurance premiums. No additional legislation is needed. The tax just moves up and down each year based on how much the free care pool needed to break even the year before.

 

NOTE: The CHCs are very good medical facilities and there are 44 of them. But everything is relative when you have six  medical facilities ranked best or close to best in the world (Mass General/Eye and Ear, Childrens', Brighams'/DanaFarber, Boston Floating for Children, Beth Israel, and Joslin) right down the street... or a subway ride away.

Valued Social Butterfly
Posts: 8,793
Registered: ‎08-18-2008

Medicaid Retroaction being rolled back in some states

Message 27 of 27 (161 Views)

People should get covered and stay covered - it is important.  Medicaid is just another form or insurance so they need to get covered - but I bet many of them think they don't have to make application - they just get it when they need it - seems that is changing in some states.  If the savings is as great as indicated - this could spread to other states.

 

Isn't health care coverage important to everybody??  If you make application on the state or federal exchange - if you qualify for Medicaid and the state has expanded its program - they send you there.  It is an annual enrollment just like private individual coverage enrollment.

 

So these are folks that haven't bothered to do anything as far as signing up for anything in their state.  Evidently health care coverage is not important to them.

 

. . . . . in most states if you qualify for Medicaid — but weren’t enrolled at the time — the program will pay your medical bills going back three months. It protects hospitals, too, from having to absorb the costs of caring for these patients.

 

But a growing number of states are rescinding this benefit known as “retroactive eligibility.”

All four states — Iowa, Arkansas, Indiana, New Hampshire have expanded Medicaid under the health law.  So, in theory, most adults are required to have insurance under the ACA. In practice, each state still has a significant number of uninsured, ranging from 5 to 8 percent of the population.

 

The retroactive coverage “can compensate for the sorts of errors and lapses that can so easily occur on the part of both the applicant and the government bureaucracy” that delay applications, said Gordon Bonnyman, staff attorney at the Tennessee Justice Center, a public interest law firm that represents low-income and uninsured residents.

 

State and federal officials say eliminating the retroactive coverage helps encourage people to sign up for and maintain coverage when they’re healthy rather than waiting until they’re sick to enroll. It also fits into federal officials’ efforts to make Medicaid, the federal-state program that provides health care for low-income adults and children, more like private insurance.

But consumer advocates and health care providers say the shift will saddle patients with hefty medical bills and leave hospitals to absorb more uncompensated care when patients can’t pay. Some worry this could be the start of a trend.

 

In Iowa, the change applies to just about anyone coming into Medicaid — except for pregnant women and children under age 1. The change will affect up to 40,000 residents annually and save the program more than $ 36 million a year.

 

more at the link ~

KHN - 11/14/2017 - Some States Roll Back ‘Retroactive Medicaid,’ A Buffer For The Poor — And For Hos...