Tag Archives: Medicaid

GOP plans to cut Medicaid would jeopardize critical health services for Wisconsin students

Wisconsin’s schools receive more than $107 million in federal Medicaid funds each year, according to data released by the Washington, D.C.-based Center on Budget and Policy Priorities. That amount is higher than in all but six other states.

The Medicaid funding pays for health care services for many of the students with disabilities, such as mental health and speech therapy. It also covers vision and dental screenings provided in schools to Medicaid-eligible children and helps schools connect low-income children to other health care services that aren’t provided in schools, but are critical to a child’s development.

“Medicaid plays a very important role in supporting students in Wisconsin’s schools. Schools depend on these payments to help provide services like speech therapy, social work services, and personal care so students with disabilities can be successful at school.” said Sally Flaschberger, lead advocacy specialist at Disability Rights Wisconsin.

House Republicans tentatively plan to bring up a health bill this week, the American Health Care Act, which would cut federal Medicaid funding by $839 billion over the next decade.

In addition to putting health care at risk for millions of adults, these efforts would jeopardize critical health-related services for students and put an important source of funds for schools and states at risk.

Jon Peacock, research director of the Wisconsin Council on Children and Families, said federal cuts to Medicaid could be especially difficult for schools in Wisconsin.

“Because our schools have done a good job of utilizing federal assistance to support school-based health services, we rank seventh highest nationally in federal Medicaid spending in schools,” Peacock said.

Medicaid provides health care for more than 1.1 million Wisconsinites, including about 500,000 children, but Peacock said many people are unaware of its significance for schools.

That’s not the case for school nurses, who are well aware of Medicaid’s importance for schools, according to Valerie Hon, president of the Wisconsin Association of School Nurses.

“Without the support they get from Medicaid, some Wisconsin schools would struggle to afford keeping school nurses and other specialized instructional support personnel on staff, give students with disabilities the services they need and are entitled to receive, and provide basic screenings for Medicaid-eligible children,” Hon said. “Policymakers in Washington should protect Medicaid — not cut it.”

According to the new report by the Center on Budget and Policy Priorities, 68 percent of school superintendents reported earlier this year that they used Medicaid funding to keep school nurses, school counselors, speech therapists, and other health professionals on staff.

Peacock said the proposed changes in health care spending would have broader implications for schools. “Medicaid cuts are also likely to impede efforts to help schools implement proven reforms such as hiring and retaining excellent teachers, reducing class sizes, and expanding the availability of high-quality early education — keys to helping all children thrive in school.”

Walker moves forward with plans to cut more people off Medicaid

Gov. Scott Walker is forging ahead with plans to move more people off Medicaid by capping benefits for childless adults who aren’t working and subjecting some to drug tests.

Details of his proposals, which require sign-off from the federal government, were posted this week for public comment.

The Wisconsin Department of Health Services plans to submit an application to the U.S. Centers for Medicare and Medicaid Services at the end of May.

Walker’s most talked about proposal would screen applicants for drug use. Applicants who refuse a drug test would go several months without coverage.

The Republican governor says his proposals would send more people to work.

Democrats argue Wisconsin should instead take federal money to expand Medicaid, as some Republican-controlled states have done.

Reaction to Walker’s plans

In a media call on April 17, representatives from Citizen Action of Wisconsin, Wisconsin Council on Children and Families and substance use disorder experts Dr. Richard Brown and Jesse Heffernan raised concerns about Walker’s plans.

They said the drug testing proposal would be costly, impractical and counterproductive.

“The whole idea is misguided. Depriving drug-addicted people of Medicaid will deprive them of high quality health care. This is the last thing we want during our current opioid epidemic,” said Brown, founder of Wisconsin Initiative to Promote Healthy Lifestyle at UW School of Medicine “The internet is full of guidance on how people who are using drugs can escape detection. Drug testing will likely not to identify most drug users and will be a total waste of time and money. Wisconsin already has many people on waiting lists to receive treatment. The longer people wait, the less likely they will actually end up in treatment. The $48 million proposed for drug testing would be much better used to reduce wait times for people who already want treatment.”

“Scott Walker is playing politics with the health and safety of people who need medical care the most. His forced drug testing proposal flies in the face of decades of medical science which has determined that substance use disorders are a disease not a moral failing,” said Robert Kraig, executive director of Citizen Action of Wisconsin. “If Walker was really interested in tackling the opioid epidemic and reduce substance use, he would fully fund voluntary prevention, screening, and treatment programs recommended by public health experts. Instead, he is playing on the worst stereotypes about people with substance use issues and all moderate income people who can’t afford to buy health coverage on their own.”

“The fact is we don’t even have the number of treatment beds in this state to handle a major influx of patients if people’s coverage is at risk,” added Jesse Heffernan of Helios Addiction Coaching. “Gov. Walker’s proposal perpetuates stigma and does not prioritize prevention. For someone who is actively using or seeking recovery, how can we expect them to pull themselves up by their bootstraps when they are facing a constant struggle. This is not the recipe to make someone a productive member of society again.”

Wisconsin has the power to make healthcare cheaper and better

The much-maligned Affordable Care Act (ACA) passed in 2010 will stay in place.

“Obamacare is the law of the land,” House Speaker Paul Ryan told the nation. “We’re going to be living with Obamacare for the foreseeable future.”

Self-employed older Americans and state budget directors breathed a sigh of relief. The Republican healthcare plan would have raised rates for older people on Healthcare.gov, shifted taxes away from the well-off, and shifted to states more costs for low-income, disabled and elderly (through Medicaid).

But the problems of the ACA — rising premiums, customers left with little choice and insurance companies leaving the marketplace in some states — still remain.

Why do these problems exist? Is there anything Wisconsin can do to improve things?

Insurance companies act to share risk. Inevitably, healthier patients subsidize the less fortunate sicker patients. This has been the case since Benjamin Franklin invented the first American insurance company (that I’m aware of) when he created a “mutual fire aid society” to help defray the risk of fire.

Insurance companies are betting you will stay healthy, you are betting you’ll get sick.

When companies entered the healthcare.gov market place, they kept premiums low. Conservative columnist David Brook wrote in 2015 “Healthcare inflation has been at historic lows.” Quoting expert Jason Furman, Brooks wrote prices were growing as an annual rate of 1.6 percent since 2010, “the slowest rate for such a period in five decades.” Federal government health expenses slowed too.

For a number of reasons, the low inflation was not sustainable. Young people were not buying their own policies but staying on their parents plan as long as possible. Many people who got insurance for the first time had numerous costs due to delayed care. Insurance companies didn’t make the money they expected, and decided to either drop providing coverage in the exchange or raise premiums to cover the higher costs.

Covering self-employed or small businesses (known in the insurance industry as “individual coverage”) has always been expensive. Administrative costs are high; risk is high. The ACA protected consumers in many ways, such as not being charged more if you had cancer but are now healthy. However, the rules left fewer ways for insurance companies to recoup costs. So, they raised premiums or completely left the individual market.

The result is higher cost insurance, less choice and in some cases no choice.

Wisconsin historically has a competitive insurance market with many competing plans, especially in the southeast. Many players should give us lower costs (however, the health care market does not follow normal economic patterns), but seeking an unprofitable venture does not make a good business model.

Which may lead us to one option. Some insurance companies are not-for-profit; some have very low overhead. Everything else being equal, these companies should be better at competing. However, so much depends on the luck — or lack of it — in taking care of a high cost patient.

We could return to a successful plan that helped health insurance companies manage risk. In 2013, Gov. Walker eliminated the state’s “Health Insurance Risk-Sharing Plan” known as HIRSP. This was a mistake.

The HIRSP plan was paid for with funds from insurance companies. We could create a similar plan to allow people with conditions that require expensive care to continue under their own insurance plan. Their insurance company could use a plan like HIRSP to share risk with other companies. Basically HIRSP 2.0 could work seamlessly in the background to help manage high-risk patients.

A recent National Governor’s Association briefing suggested states could save up to 15 percent on insurance premiums if they created such a plan. Other state innovations could include promoting enrollment in the healthcare marketplace, and focusing on methods to reduce the cost of care.

In a 2015 report, Citizen Action of Wisconsin proposed several changes that could bring down health insurance premiums. Medicaid expansion could cover an estimated 81,000 Wisconsinites through existing federal law and bring many high cost patients into a less expensive system. Creation of a Wisconsin-based marketplace, state scrutiny over premium hikes, use of state purchasing power to gain value — lower costs and better care — are all options that merit investigation.

Healthcare policy is complex. But solving problems is possible. If those in Washington have given up, let’s consider new ideas at our state Capitol. We might land on an idea that really works.

Sen. Kathleen Vinehout, D-Eau Claire, represents Wisconsin’s 31st Senate District.

 

Trump budget is survival of the fittest

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American Medical Association urges defeat of House health care bill

Citing projections that millions of people would lose coverage if the American Health Care Act were to become law, the American Medical Association urged members of Congress to oppose the amended legislation.

The AMA, in a press statement, said it would continue working with Congress to increase the number of Americans with quality, affordable health insurance, but the bill, as currently drafted, pushes policy in the wrong direction.

The AMA is nation’s largest physician group.

“Health insurance coverage is critically important,” the AMA stated in a letter to House members. “Without it, millions of American families could be just one serious illness or accident away from losing their home, business, or life savings.

“The AMA has long supported the availability of advanceable and refundable tax credits, inversely related to income, as a means to assist individuals and families to purchase health insurance.  The credits proposed under the AHCA are significantly less generous for those with the greatest need than provided under current law.  The reduced purchasing power with the AHCA tax credits will put insurance coverage out of reach for millions of Americans.”

The letter continued: “We also remain deeply concerned with the reduction of federal support for the Medicaid program and the resulting significant loss of coverage.  Medicaid expansion has provided access to critical services, including mental health and substance abuse treatment, for millions.  Not only will the AHCA force many states to roll back coverage to these millions of previously ineligible individuals, but the significant reduction in federal support for the program will inevitably have serious implications for all Medicaid beneficiaries, including the elderly, disabled, children, and pregnant women, as well.”

The letter concluded: “We continue to stand ready to work with Congress on proposals that will increase the number of Americans with quality, affordable health insurance coverage but, for the reasons cited above, urge members to oppose the American Health Care Act.”

Last week, the AMA launched a new website, patientsbeforepolitics.org, aimed at encouraging physicians and patients to join the effort to increase access to affordable, meaningful coverage for all Americans.

The interactive site provides the information on health care legislation moving through Congress, as well as the AMA’s efforts to help “shape the future of U.S. health care.”

In January, the AMA released its health system reform objectives — primary among them that people who currently have insurance should not become uninsured — and shared them with members of Congress.

Mayo Clinic faces questions over CEO’s ‘prioritized’ patients remark

Mayo Clinic is facing questions from the state of Minnesota after its CEO told employees that if patient conditions are equal, its hospitals should prioritize privately insured patients over those under government-subsidized programs such as Medicaid.

John Noseworthy’s comments were made late last year in a videotaped speech to staff but surfaced only this week after a transcript of his speech was obtained by the Star Tribune newspaper.

The Mayo Clinic has verified the transcript is accurate.

Noseworthy said in a statement that medical need will always be the top factor in scheduling an appointment.

“In an internal discussion I used the word ‘prioritized’ and I regret this has caused concerns that Mayo Clinic will not serve patients with government insurance. Nothing could be further from the truth,” he said, adding that the hospital is committed to serving patients with government insurance.

“Changing demographics, aging of Americans and budgetary pressures at state and federal government pose challenges to the fiscal sustainability in healthcare today,” he said. “While these discussions are uncomfortable, they are critical for us to be able to meet the needs of all of our patients.”

Minnesota Department of Human Services Commissioner Emily Piper said she was surprised and concerned by Noseworthy’s earlier comments and has questions about what they really mean and how Noseworthy’s directive would be carried out.

The department is looking into whether there are possible violations of civil and human rights laws.

The agency also is reviewing its contracts with Mayo Clinic to ensure the hospital is meeting its obligations to serve patients in public programs.

Last year, Noseworthy told staff that when Mayo Clinic has expertise that can’t be found elsewhere, it will always take patients, regardless of how they are paying for care.

“We’re asking. if the patient has commercial insurance, or they’re Medicaid or Medicare patients and they’re equal, that we prioritize the commercial insured patients enough so . we can be financially strong at the end of the year to continue to advance our mission,” Noseworthy said in the transcript.

Mayo Clinic spokeswoman Duska Anastasijevic said the speech stressed the need to increase privately insured patients, but not at the expense of government insured patients.

Mayo Clinic said about half of the services it provides go toward those enrolled in government programs. The clinic said it provided $629.7 million in care to people in need in 2016, including $546.4 million that wasn’t covered by Medicaid or other programs for the uninsured or underinsured.

The statement said that as Mayo’s percentage of publicly funded patients has grown, to now roughly 50 percent, the health system is working to increase commercially insured patients.

“To fund its research and education mission, Mayo needs to support its commercial insurance patient numbers in order to continue to subsidize the care of patients whose insurance does not cover the cost of their care,” the statement said.

Piper said Noseworthy’s statements do not reflect routine hospital practices and she found them to be troubling.

As Human Services commissioner, Piper is focused on ensuring access to health care for those enrolled in public programs. She said providers have to follow the law and uphold agreements to provide such care. She said that in her view, nothing that is happening with the health care law on the federal level changes those requirements.

“Health insurance coverage for health insurance coverage’s sake is not the end goal,” she said. “It’s access _ that’s what’s important.”

Anastasijevic said Minnesota Medicaid patients are and will continue to be scheduled the same as patients with commercial insurance.

On Medicaid money, GOP has win-or-lose proposition for states

New England’s bucolic countryside looks much the same on either side of the Connecticut River separating Vermont from New Hampshire. But Medicaid beneficiaries are far better off in Vermont.

Vermont generously funds its Medicaid program. It provides better benefits, such as dental care, and pays doctors more than New Hampshire’s program does. That brings more doctors into the program, giving enrollees more access to care.

New Hampshire has twice Vermont’s population, but Vermont spends almost as much on Medicaid and covers more enrollees. Under the complicated formulas that set federal funding, Vermont’s substantial investment helps it capture nearly as much aid from the government as New Hampshire gets.

States’ policies differ about who or what to cover in Medicaid, and those decisions have led to historical variances in how much federal money they receive. House Republicans’ effort to shrink federal Medicaid spending would lock in the differences in a way that favors those already spending high amounts per enrollee.

“Republicans are finding out why changing Medicaid is so hard and why the easiest thing to do is to do nothing given the substantial variation in federal spending across states,” said John Holahan, a health policy expert with the nonpartisan Urban Institute.

Here’s why.

Medicaid, the national health program for low-income people that covers about 1 in 5 Americans, is 60 percent funded by the federal government and 40 percent by states. Total spending in 2015 was about $532 billion, according to the latest official data.

Federal funding is open-ended, which means the government guarantees states it will pay a fixed rate of their Medicaid expenses as spending rises.

Those matching rates are tied to average personal incomes and favor the lowest-income states. Mississippi has the highest Federal Matching Assistance Percentage — 76 — while 14 wealthy states, including New York and California, get the minimum 50 percent from the federal government.

But state Medicaid spending varies significantly, too, and that influences how much federal money each receives to fund its program. State policies about how generous benefits should be and how much to pay doctors and hospitals account for those differences.

GOP leaders want to give states a set amount of money each year based on the number of Medicaid enrollees they had in 2016, a formula known as per-capita caps.

A per-capita system would benefit high-spending states already receiving relatively rich allotments from the government, the Urban Institute said in a paper last September.

According to its estimates, if the system were in effect this year, Vermont would receive $6,067 per enrollee — one of the highest allotments in the country — while New Hampshire would get the least, just $3,084 per enrollee.

Per-capita caps would limit the government’s Medicaid spending because it would no longer be on the hook to help cover states’ rising costs. But caps also would shift costs and financial risks to the states and could force them to cut benefits or eligibility to manage their budgets.

“It would present a huge problem,” said Adam Fox, a spokesman for the Colorado Consumer Health Initiative, an advocacy group.

Under the GOP bill, federal Medicaid funding to states would be adjusted annually based on a state’s enrollment and medical inflation. But that would not be enough to keep up with rising Medicaid spending per enrollee, which would force states to put up more of their money or scale back the program, the nonpartisan Congressional Budget Office said March 13.

Other analyses of the GOP plan have reached the same conclusion.

Since 1999, however, the average annual growth rate in Medicaid spending per enrollee has risen more slowly than medical inflation, according to MACPAC, the Medicaid and CHIP Payment and Access Commission, which advises Congress.

Republicans argue that overhauling federal Medicaid spending as they propose would hold down federal costs while giving states more leeway to run their programs as they see fit. “This incentive would help encourage efficiencies and accountability with taxpayer funds,” House Speaker Paul Ryan wrote last June in his white paper, A Better Way.”

Rep. Greg Walden (R-Ore.), chairman of the powerful House Energy and Commerce Committee, which has oversight of health care matters, sounded a similar note at a press conference in Washington, D.C., when the GOP plan was announced. “I think it’s really important to empower states and to put Medicaid on a budget,” he said.

But Fox argued the opposite would happen under a per-capita system — instead of gaining more control over their Medicaid programs, states would not be able to meet their needs because they’d have fewer dollars to decide how to spend, he said.

Bill Hammond, director of health policy for the nonpartisan Empire Center for Public Policy in New York, said House leaders’ decision to tie future Medicaid funding to medical inflation could help mute concerns that funding wouldn’t keep up with rising costs, but would not address the fairness issue of giving some states higher per-capita amounts than others.

“If a low-spending state decides it wants to spend more money on paying hospitals and doctors or adding more benefits, they would have a harder time doing that without breaking the federal cap,” he said.

Medicaid advocates in New Hampshire are worried because their state has few alternatives to make up for a loss in federal funding. New Hampshire lacks an income or sales tax.

“There is a tremendous amount of fear among families here as Republicans try to dismantle the ACA,” said Martha-Jean Madison, co-director of New Hampshire Family Voices.

Published under a Creative Commons license. Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.

Spring storm: Activists gathered outside Ryan’s Racine office to protest health care plan

About 250 people from Illinois and Wisconsin assembled outside House Speaker Paul Ryan’s office in Racine March 14 to demand he drop his health care repeal plan.

The demonstration took place days after the Congressional Budget Office’s analysis showed the House GOP health plan would cause 24 million Americans to lose their health coverage.

People from Fair Economy Illinois and the Jane Addams Senior Caucus joined with members of Citizen Action of Wisconsin — all People’s Action organizations — and with SEIU Healthcare Wisconsin and the Wisconsin Alliance for Retired Americans.

Protesters marched from Racine’s Monument Square on Main Street to Ryan’s office with cans of dog and cat food — the kind of lunch organizers say some seniors will have  if House Republicans pass their health plan is passed.

Outside the speaker’s office, people shared stories and fears of living without health insurance.

Reggie Griffin, of Chicago, is in his 70s and works as a home caregiver. He said he would be devastated by the defunding of Medicare because of chronic health conditions. “I want to live a life of dignity,” Griffin said, according to a news release from organizers of the protest. “There are some members of Congress, like Speaker Paul Ryan, who think I don’t deserve to live with dignity.”

“This is a huge test for our democracy, because the Republican repeal can’t survive once the people understand it’s true implications,” said Robert Kraig, executive director for Citizen Action of Wisconsin.

“This attack on seniors and families will devastate Midwest communities. It is irresponsible and ruthless,” added Anna Marin, manager of civic engagement for the Jane Addams Senior Caucus.

One of the speakers at yesterday’s action, Tammy Wolfgram, is a small business owner from Hartland.

Before the passage of the Affordable Care Act, Wolfgram, her husband and her daughter could not find any health insurance company that would sell them coverage because all three had pre-existing conditions.

She said they struggled to afford costly insurance with high deductibles on Wisconsin’s high-risk pool.

“If ACA is repealed, I don’t know what we will do,” Wolfgram said.

A report by the Congressional Budget Office released this week shows 14 million people will lose their insurance coverage by next year and 24 million by 2026.

“Anyone who believed GOP promises that people would still have health insurance under the Republican repeal plan now know that they were lied to; they are going to be left out in the cold,” said LeeAnn Hall, co-director of People’s Action and executive committee member of Health Care for America Now.

Deciphering CBO’s estimates on the Republicans’ health bill

The Congressional Budget Office is out with its estimate of what effects the Republican health bill, “The American Health Care Act,” would have on the nation’s health care system and how much it would cost the federal government.

The GOP plan is designed to partially repeal and replace the Affordable Care Act passed during the Obama administration.

Here are some of the CBO highlights:

• $337 billion reduction in the deficit. That’s CBO’s estimate over the next decade, taking into account both decreased government spending in the form of less help to individuals to purchase insurance and lower payments to states for the Medicaid program. It also includes decreased revenue from the repeal of the taxes imposed by the ACA to pay for the new benefits.

• 24 million more people without insurance in a decade. The federal budget experts estimate that people will lose insurance and that the drop will kick in quickly. In 2018, they say 14 million more people would join the ranks of the uninsured. It would reach the 24 million by 2026, when “an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.”

• 15 percent of Planned Parenthood clinic patients would “lose access to care.” These patients generally live in areas without other sources of medical care for low-income people. The Republican bill would cut out Medicaid funding for Planned Parenthood for a year.

• 15 to 20 percent increase in 2018 premiums, but relief would follow. Monthly costs for insurance would go up at first, due to the elimination of the requirement for most people to have insurance or else pay a tax penalty. After 2018, CBO estimates that average premiums would actually drop by 10 percent by 2026 compared to current law. That is because the lower prices for younger people would encourage more to sign up. By contrast, the law would “substantially [raise] premiums for older people.”

• 95 percent of people who are getting Medicaid through the health law’s expansion would lose that enhanced federal funding. The CBO estimates that only 5 percent of enrollees in the expansion program would remain eligible for the higher federal payments by 2024, since the bill would phase out those payments to states as patients cycle in and out of eligibility.

• 14 million fewer Medicaid enrollees by 2026. That’s 17 percent fewer than projected under current law. The projection includes people who are currently eligible and would lose coverage, as well as people who might have become eligible if more states, as expected, expanded coverage under the ACA. CBO projects that is unlikely to happen now.

• $880 billion drop in federal Medicaid spending over the decade. That comes primarily by imposing, for the first time, a cap on federal contributions to the program for those with low incomes.

Published under a Creative Commons license. Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.