Medicaid Wars (warning: boring)
It is a policy wonkish article, but I post it to see if anyone wishes to kill time discussing the following issues. http://www.nytimes.com/2010/09/20/nyregion/20medicaid.html?_r=1&pagewanted=2&ref=nyregion&src=me Are we willing to have 1/3 of our taxes go toward providing health care to the poor and working poor? Should New York state have the "broadest" eligibility requirements and coverage of any state? ....can one ask such questions and not be accused of being a Tea Party member or Hitler? When the public learns that programs they would love to implement have very large costs attached to them, do they still want to -um- implement them?For better or worse, the change on Nostrand is going to make the change on Franklin look minor.
Those who believe that health care is a universal right, and a right that should be free of charge and without limits, really do dislike those who are brave enough to ask "how are we going to pay for all of this?"For better or worse, the change on Nostrand is going to make the change on Franklin look minor.
Subject: Re: Medicaid Wars
whynot_31 » ....can one ask such questions and not be accused of being a Tea Party member or Hitler?I'm not sure you can even ask the meta-question without being called Hitler. But maybe that's because you're a commie-nazi!
Subject: Re: Medicaid Wars
Mougar » [quote="whynot_31"]....can one ask such questions and not be accused of being a Tea Party member or Hitler?I'm not sure you can even ask the meta-question without being called Hitler. But maybe that's because you're a commie-nazi![/quote] Yes, I have simultaneously managed to occupy both ends of the politicial spectrum. I have been working on this for years. <<<< waits patiently for someone to accuse me of not caring how much we spend on things like prisons, department of defense, and police. Has "but I do" response ready.For better or worse, the change on Nostrand is going to make the change on Franklin look minor.
whynot_31 » Those who believe that health care is a universal right, and a right that should be free of charge and without limits, really do dislike those who are brave enough to ask "how are we going to pay for all of this?"I didn't say they didn't dislike each other. I said the "Hitler" accusations were used almost exclusively by one side of the debate. (hint: not the pro-reformers)
Yup, and I'm disagreeing. I've spent waaaaay too much time with the pro-reformers. They are convinced that anyone who is against health care reform and expansion is a horrible person. I think there are even numbers on each side. Quick, lets grab magazines from the left and the right! I get the The Nation and Mother Jones .....You get the National Review and the Heritage Foundation newsletter. By circling paragraphs that insult the other group, let's decide who hates the other more. Extra points to the one who finds the most Hitler references. OMG, the article touches upon the issue of tort reform! not that! P.S. Can't one just wonder how the heck we are going to pay for all this and not be a bad person?For better or worse, the change on Nostrand is going to make the change on Franklin look minor.
While I appreciate your personal anecdotes, photography from tea party rallies and the like undermine your claim. I'm heavily invested in the progressive community and I can't remember the last time I read or heard of someone calling an anti-reformer "Hitler".
It is difficult to compete with the Rush Limbaughs and Glen Becks, they might make your case on shear frequency. ....but I predict I would get called names merely for wondering how we will pay for all this. ....this will happen despite me being pro-reform. I will at least be assumed to be a Tea Party member. How are we going to pay for all of this?For better or worse, the change on Nostrand is going to make the change on Franklin look minor.
whynot_31 » It is difficult to compete with the Rush Limbaughs and Glen Becks, they might make your case on shear frequency. ....but I predict I would get called names merely for wondering how we will pay for all this. ....this will happen despite me being pro-reform. I will at least be assumed to be a Tea Party member.I think you're exaggerating just a bit here.
whynot_31 » How are we going to pay for all of this?A difficult question for sure, but the status quo is untenable. Health care will increasingly bankrupt more and more Americans unless we rein in costs. And while tort reform is important, it won't come close to getting the job done.
I've been called far worse than a Tea Party member for proposing that Health Care costs must be contained. ....and end of life care rationed. Forget the individuals who are being bankrupt by unexpected, uncovered expenses ....such aggregate costs are likely to futher bankrupt our already bankrupt country. Let's do tort reform. and deductibles. Now let's do things no one likes to think about: Implement Lifetime maximum benefits. Legalize doctor assisted suicide, and make it accessible. ....surely I'll be called a Hitler soon.For better or worse, the change on Nostrand is going to make the change on Franklin look minor.
I want to know how we are going to pay for this. ....and if people think we are ready change the nature of our society in order to do it. --either we are going to shell out lots of $, or we are going to restrict what people currently percieve as "rights". i.e. The rights to sue for a huge amount of $ The right to consume care without limit or consequence. ....I'm interested in seeing how this will play out on the ground in broke states, like Mississippi. The whole debate over health care skirted these issues, and they keep coming up ....here they are coming up with regard to medicaid (the closest thing we have to universal, limitless coverage in NYS). ....how big are we going to let it grow? Who, if anyone, is going to take on the very difficult issues it brings up? At somepoint, Grandma is going to die ....what is our collective responsbility for her? ...can we at at some point state that we are not going to pay for additional care? .....is advancing technology going to continue to enhance our ability to prolong life, and multiply costs? (do I secretly hate grandmothers?)For better or worse, the change on Nostrand is going to make the change on Franklin look minor.
i think this is why the smart people seem to say that we need to push down the actual costs and eliminate waste.
Agreed. But at what point do we give ourselves permission to: pursue reduced costs and waste by imposing lifetime benefit limits? ....or declining coverage for treatments that will simply prolong the life of someone who is terminally ill? So far, most of the health reforms I've seen just force the private health insurance companies to act more like Medicaid. ....which causes more people to remain on private insurance instead of ending up on Medicaid, but doesn't address the issues of skyrocketing costs and America's belief that it can somehow stop (or at least not look at) death.For better or worse, the change on Nostrand is going to make the change on Franklin look minor.
we are already paying an awful lot of money for something else that is of no use to anyone. how much of your paycheck goes to insurance? how much of your company's (or state's) money goes there? how much of that money do you think goes to health care vs. to insurance company administration? (hint: the insurance company has an interest here....) if we started spending the amount of money we spend on "health care" on health care, that would be really something.Bumping ancient threads with bot-like bullshit
absolutely. There are admins and bureaucrats and auditors, all of which profit from the present state of inefficiency. Making the leap to electronic records and billing alone could provide huge savings.For better or worse, the change on Nostrand is going to make the change on Franklin look minor.
whynot_31 » I want to know how we are going to pay for this. ....and if people think we are ready change the nature of our society in order to do it. --either we are going to shell out lots of $, or we are going to restrict what people currently percieve as "rights". i.e. The rights to sue for a huge amount of $ The right to consume care without limit or consequence. ....I'm interested in seeing how this will play out on the ground in broke states, like Mississippi. The whole debate over health care skirted these issues, and they keep coming up ....here they are coming up with regard to medicaid (the closest thing we have to universal, limitless coverage in NYS). ....how big are we going to let it grow? Who, if anyone, is going to take on the very difficult issues it brings up? At somepoint, Grandma is going to die ....what is our collective responsbility for her? ...can we at at some point state that we are not going to pay for additional care? .....is advancing technology going to continue to enhance our ability to prolong life, and multiply costs? (do I secretly hate grandmothers?)eliminate the middle men
whynot_31 » absolutely. There are admins and bureaucrats and auditors, all of which profit from the present state of inefficiency. Making the leap to electronic records and billing alone could provide huge savings.Somehow dramatically reduce advertising and marketing budgets, which account for some ungodly percentage of health care costs.
All good ideas. ...and if costs continue to grow, can we then address the hard questions?For better or worse, the change on Nostrand is going to make the change on Franklin look minor.
Bro, you totally Godwinned yourself in your first post =D>(\__/)
Mamacita » Bro, you totally Godwinned yourself in your first post =D>Sometimes you gotta preempt folks. Maybe not these folks, but they are out there. People don't like people talking about how they want to deny care to their dying grandmother.For better or worse, the change on Nostrand is going to make the change on Franklin look minor.
Plus: This post was not written by me. Minus: This post is really long. What Will The Next Governor Do To Reform Medicaid? Mounting Challenges Face A Program That Continues To Expand By Jerry Zremski Buffalo News September 26, 2010 The government program that tries to keep nearly a quarter of New York State's residents healthy has made the state budget morbidly obese. Carl Paladino's solution? The Republican candidate for governor wants to cut the fat and much more, slicing off 40 percent of the state Medicaid program's body weight in one fell swoop. Can it be done? Probably not without breaking federal law, and probably not without shattering the state's economy, experts say. Meanwhile, Democrat Andrew Cuomo wants to put Medicaid on a diet. He proposes changing who decides how doctors and hospitals are paid, while putting the state in charge of a program it now shares with its counties. Does that solve the problem? Not even close, the experts say. That's because over decades, New York transformed its Medicaid program from an insurer of last resort for the poor into a sprawling entitlement whose biggest expenses are for long-term care for the elderly and the disabled -- many of them middle-class. And that has spawned an industry and a clientele with the political power to guard -- and grow -- Medicaid's girth. Controlling Medicaid costs will be one of the biggest challenges facing the next governor, which is why the sprawling health program is the first of several big issues that The Buffalo News plans to examine in depth during the race for governor. With Medicaid costs increasing as the recession drove more people into the program, the next governor and the Legislature cannot ignore a program that's its single largest expenditure -- and that, on a per-patient basis, costs 64 percent more than the national average. But cutting Medicaid so won't be easy. "It will take decades to get it back in line with the rest of the country," said Courtney Burke, who directs the Rockefeller Institute's New York State Health Policy Research Center. Paladino's Problem The Republican candidate for governor begs to differ with the experts, saying he could quickly cut $20 billion from the $50 billion program, which gets half its money from the federal government and the rest from the state and its counties. "Medicaid is probably the single biggest cause of New York's stagnant economy," the Paladino campaign says on its Web site. "The burden it lays [on] local governments is one of the main reasons why New Yorkers suffer the highest taxes in America." While Paladino has been criticized for failing to say exactly how he would cut Medicaid by 40 percent, he offered some details in an interview with The Buffalo News last week. First on Paladino's agenda would be cutting waste, fraud and abuse, which he says has worked in some counties. "We're not going to get every bit of it, but we're certainly going to tighten up on the rules," he said. "The rules now encourage it." The candidate proposes fingerprinting and drug-testing Medicaid and welfare applicants before they can receive benefits, just to prove their identity and ensure that they are eligible. But experts said any attempt to narrow Medicaid eligibility will run into a brick wall: the health reform bill Congress passed in March. That bill includes a provision that says states cannot trim eligibility requirements for Medicaid until Jan. 1, 2014 at the earliest -- three years into the next governor's term. States that cut eligibility before then risk losing all their federal Medicaid funding. That provision of the health care bill is a particular problem for New York because, over decades, the state has set up all sorts of benefits under Medicaid that other states offer under other programs or don't offer at all. Most notably, the federal law will force the state to maintain eligibility requirements for nursing home care and home care for seniors. "New York has designed a program with loopholes that let well-to-do people shift their assets and get Medicaid coverage [for long-term care]," said Elizabeth Lynam, deputy research director at the Citizens Budget Commission in New York. And because of health care reform, changing that will be difficult. "We're going to have trouble closing those loopholes," said Lynam, author of a 2006 study examining ways to reform Medicaid in the state. While the federal health law won't allow states to trim eligibility requirements, it will allow them to cut optional programs -- which is something else Paladino proposes. While he has not specified all the optional benefits he would cut, there are a huge range of choices, including care for the developmentally disabled, hospice care and dentistry. But there is a problem with that. "There's no savings in optional benefits at all," Lynam said. "It's chump change. You cut the optional benefits, and people would go out and get more expensive care. They'll go to the emergency room instead of the dentist." Moreover, the cost of additional services like dentistry pales in comparison to the cost of covering long-term care for seniors and the disabled -- which in New York accounts for nearly three-quarters of all Medicaid spending. Because of the generosity of New York's programs for those people and the state's higher overall cost structure, spending on care for those people is truly out of line. New York spends 77 percent more per patient than the national average in caring for the elderly, and nearly double the national average on Medicaid for the disabled. So what happens if you want to cut Medicaid by 40 percent in the state? "You couldn't do that without dramatically impacting seniors and persons with disabilities -- because that's where the money is," said Vernon K. Smith, a consultant with Health Management Associates and a former director of Michigan's Medicaid program. And by dramatically cutting services for seniors and the disabled, you would be cutting jobs -- something Paladino freely admits he is willing to do. Experts say, though, that the scope of layoffs likely would be vast in a state where more than a million people earn a paycheck through health care. “You'd see large layoffs," said Kip Piper, a health care consultant who formerly served as Wisconsin's Medicaid director. "You'd see institutions closing. You'd have a lot more unemployment." Cuomo's Conundrum In contrast to Paladino, Cuomo offers a tinkering-around-the-edges overhaul of the program. "[People say] we have to cut Medicaid. No, you don't have to cut it," the Democratic candidate said at a Buffalo News editorial board meeting on Friday. "Medicaid is hugely wasteful and inefficient. Don't trim Medicaid. Redesign Medicaid, overhaul Medicaid." To do that, Cuomo offers several specific proposals that many experts laud -- while acknowledging they may not be politically palatable, and that they wouldn't come close to bringing New York's Medicaid spending in line with other states. First and most radically of all, Cuomo would end the counties' role in managing and funding Medicaid. One of the few states to rely on counties for funding, New York now gets about 17.5 percent of the program's money from counties -- meaning the program is responsible for about half the county property taxes in the state. From an efficiency standpoint, a state takeover of the program is "a no-brainer," said Burke, of the Rockefeller Institute. Yet the move might not result in huge and immediate cost reductions, she added. That's because county employees now working for the counties might well have to transfer over to the state. Do that and they would likely enjoy richer benefits under union contracts. Cuomo also wants to take the responsibility for setting reimbursement rates for medical providers out of the hands of the State Legislature. Instead, that responsibility would shift to a nonpolitical entity within the Department of Health. In theory, that would stop the state's huge medical industry from pressuring legislators for more money. But in practice, many wonder if legislators are willing to give up such power, and whether hospitals, health employee unions and other vested interests will stand in the way of such a move. "Every option that is easy or politically feasible has been tried," Smith noted. Piper, meanwhile, wonders whether those hospitals, health employee unions and other vested interests will stand in the way of change. "For some, [health care] is economic development," he said. "If you're in long-term care, Medicaid is 60 to 100 percent of your business. And in New York City, is there anything really more powerful than the hospitals?" Cuomo has faith that he can deal with all the special interests. And he'll have to, given that his plan also calls for better coordination of care for the most costly Medicaid patients and an effort to jawbone cost controls into effect. "Bring the stakeholders in the room -- nursing home operators, unions, home health aides," he said Friday. "Say we need to reduce the budget by say $1 billion. You tell me how to make the program work better, how to redesign the program. We can adjust the reimbursement rate, or we can redesign." Such an approach worked successfully in Wisconsin, he said -- adding that the health industry and unions would be amenable to it, because the only alternative would be to reduce their payments. Still, experts are skeptical that such an approach can lead to quick change. "You can talk about improving the management structure," said James R. Tallon Jr., chairman of the Kaiser Commission on Medicaid and the Uninsured and president of the United Hospital Fund of New York. "Then you move into the debates -- and they are going to be endless debates." It's only realistic to expect the state's Medicaid program to be cut by somewhere between $2 billon and $5 billion over a few years, said Lynam, of the Citizens Budget Commission. And that would be just the beginning of what would be an ongoing effort to curtail a program that, over decades, New York designed to get too big. "There's not going to be one answer to this," Tallon said. Over time, "there's likely to be 20 answers." ----- Charts: Candidates' stances on Medicaid: http://www.buffalonews.com/incoming/article201769.ece/BINARY/0926governor.pdf -- Spiraling costs of Medicaid http://www.buffalonews.com/incoming/article201764.ece/BINARY/0926medicaid.pdf News Staff Reporters Robert J. McCarthy and Susan Schulman contributed to this report. http://www.buffalonews.com/city/politics/article201371.ece ----------------- Paladino Campaign Remains A Work In Progress By Jimmy Vielkind Albany Times Union September 26, 2010 ALBANY -- Carl Paladino's campaign rhetoric is a steady diet of red meat: He's mad as hell and fed up with Albany, a town he promises to clean up with "a baseball bat." That message earned the Buffalo developer a resounding victory in the Sept. 14 Republican primary against Rick Lazio, but now that he's moved into a general election race against Attorney General Andrew Cuomo, there are growing calls for Paladino to focus more substantively on the issues. "We're at an inflection point in this campaign," said Paladino's campaign manager, Michael Caputo. "We're putting the flesh on the bones now." Paladino was not available for an interview for this article. "I'm not going to interrupt Carl's fundraising right now, while it's raining (donations), for press inquiries that can be dealt with by other means," he said. But in comments Paladino has made in the five months since he announced his run, his platform has included elements that have attracted considerable controversy. Consider his desire -- repeated often on the campaign trail and in ads -- to cut state spending by 20 percent and taxes by 10 percent. When pressed on how he would do this, Paladino has said he would cut $20 billion from the state's Medicaid program. "I cannot not even begin to contemplate how that could be done, but it would be devastating to the program or the people who need it," said Lara Kassel, a coordinator with Medicaid Matters, a patients' advocacy group. Caputo said the savings will be achieved by cutting the "gold-plated" options in New York's Medicaid offerings. The federal government mandates individual states cover some things, but leaves other coverage -- like prescription drugs -- up to them. New York opts in to everything, and as such receives a high federal share. Caputo said Paladino's goal would be to bring New York's per-patient spending in line with California's, because "no one can tell me, or Carl, or anyone that California has an inhumane system." But the difference is not so much in options, according to Elisabeth Benjamin of the Community Service Society, but in the costs of reimbursement rates to hospitals and nursing homes. The "gold-plated" options Paladino refers to, she said, include services like dental care. "I don't know how he gets to $20 billion. Dental, vision and adult diapers does not add up to $20 billion," she said. "That's not where your big savings are. Saying a guy shouldn't get dentures, rendering him completely unemployable, is the wrong way to look at New York's Medicaid system." The problem with adjusting reimbursement rates is facing the twin 800-pound gorillas of the union representing health care workers -- SEIU 1199 -- and the coalitions of hospital and nursing home owners. It's hard for Paladino to get into much depth about his plans, according to E.J. McMahon, director of the Empire Center for Policy, a fiscally conservative think tank. "School aid is just like a spigot -- you turn it up or down. Medicaid has got all sorts of moving parts and federal entanglement," said McMahon, who has been watching state campaigns for 30 years. Paladino's plan "is not that many iterations behind the level of detail that Cuomo's got, honestly. But anybody waiting for a more detailed plan from anybody is going to keep waiting a long time." The crux of Paladino's campaign is to blow up those special interests. Caputo said Paladino won't care if the health care lobby airs ads showing people in wheelchairs denouncing him, as they have done to previous governors….. ---------- New York's Medicaid Mess Demands Reform Newsday Editorial September 27, 2010 For millions of poor New Yorkers, Medicaid is a lifesaver. For state and county budgets, unfortunately, it threatens to become a death sentence. The problem is twofold. First, health-care costs are rising at unsustainable rates all across America. And second, New York's uniquely broad eligibility, range of covered services and generous reimbursement rates make Medicaid especially expensive here. The result, at nearly $53 billion a year, is the nation's costliest such program and perhaps the largest single factor in the state's ongoing fiscal crisis. A federal stimulus initiative giving the state extra money toward Medicaid will run out in June, even though high unemployment has driven many more people into the program. By 2013-14 the yearly cost is expected to exceed $63 billion - at which point Medicaid rolls are sure to swell further, as a result of expanded eligibility under this year's federal health-care reform law. It's easy to deride Medicaid as a waste-ridden form of welfare covering people who, perhaps because of their own bad choices, can't provide for themselves. But the reality is that nearly half of Medicaid spending in New York is for nursing homes and other forms of long-term care. In fact, per beneficiary, the state spends little more than the national average on children covered by Medicaid - but around twice the national average on the elderly or disabled. Some of these Medicaid nursing-home recipients are middle-class New Yorkers who, with the help of a cottage industry of specialists, have handed off assets to relatives in order to qualify for aid. Is that fair? Or, as this group would pose the question, is it fair to reward a lifetime of thrift with crushing nursing-home bills, while others who may have been profligate get government-paid care? Or should we find a way to cover all, perhaps through some insurance plan? It's time to have this debate out in the open, before Medicaid leads the prudent and the profligate alike to the poorhouse. Unfortunately, Medicaid is particularly resistant to reform in New York. By covering nearly a quarter of all New Yorkers, the program has an enormous number of constituents with good reason to defend it, and the health-care industry (and its unions) wields considerable clout in Albany, where the legislature has kept for itself rate-setting powers that elsewhere are left to nonpolitical experts. This may be one reason Medi-caid here costs two-thirds more per beneficiary than the national average. Aside from the very real needs of Medicaid beneficiaries, the program is also hard to cut because most of the time Uncle Sam pays half the state's tab for the program - which means that you have to slice $2 in overall spending to save state and county governments $1. New York's lieutenant governor, Richard Ravitch, has waded into this vast thicket of politics and entitlement and last week emerged with solid recommendations for reform to launch this important debate. Ravitch sidestepped difficult questions about who should be eligible and what should be covered, but he has at least laid out a sensible plan for rescuing the program, no matter how large we decide it should be. One important recommendation is for the legislature to loosen its iron grip on reimbursement rates in favor of an expert panel whose recommendations on rate-setting lawmakers can follow. This would help insulate the process from the influence of those who stand to profit from higher rates. Ravitch is also urging that more Medicaid recipients be moved into managed care, where the program would pay per patient rather than per service, removing the incentive to overtreat. The report notes that just 15 percent of beneficiaries - all fee-for-service - account for 40 percent of spending. Moving these people into managed care might save $10.8 billion over a decade, the report says. The report recommends increasing prevention efforts aimed at substance abuse and childhood obesity. And it suggests reforming the state's medical malpractice system, a notion worth considering but unlikely to get very far, given that New York's powerful Assembly speaker, Sheldon Silver, is a member of a leading personal-injury law firm - and has blocked previous efforts at tort reform. Nonetheless, the Ravitch report says capping noneconomic damages, establishing specialized courts and other such steps could lower malpractice premiums and save hospitals and physicians more than $500 million annually. Ravitch also wants the state to eradicate unfair and inefficient county-by-county differences in services and eligibility by taking Medicaid administration entirely away from the counties. Finally, the report urges action to win more Medicaid reimbursement from Washington, whose formula gives New York the lowest possible rebate of 50 percent because the state's relatively high average affluence masks a large population in poverty. The report says little about the asset-shuffling problem, and on the potential of a fledgling program to pay people to care for family members at home. The former will need to be faced, and the latter expanded. But the Ravitch proposals are a great start. Let's hope they can be enacted before the taxpayers bleed to death.For better or worse, the change on Nostrand is going to make the change on Franklin look minor.
Medicaid Enrollment Hit 47 Million, 15% of U.S. Population As of March 2009, about 47.7 million Americans were enrolled in Medicaid, about 15.6% of the total U.S. population (approximately 304 million). The 2009 Medicaid enrollment was about 40% higher than the 28.5 million enrolled in 1999 (when about 10% of the population was covered by Medicaid). Medicaid represented about half of all those covered by government health insurance in 2009, with Medicare covering 43.4 million and military health care covering 12.4 million. Of the 194 million people covered by private health insurance, 169.6 million had employment-based coverage and 27.2 million had direct purchase insurance. About 50 million people were uninsured. These were among the findings of a report, titled “Income, Poverty, and Health Insurance Coverage in the United States: 2009,” released by the U.S. Census Bureau. Additional findings about Medicaid enrollment in 2009 included the following: About half, 25.3 million of those enrolled in Medicaid, were under the age of 18; this group represented nearly 34% of all children under age 18. 4.4 million were between the ages of 18 and 24, representing about 15% of all Americans in this age group 4.2 million were between the ages of 25 and 34, representing about 10% of all Americans in this age group 3.5 million were between the ages of 35 and 44, representing about 8.8% of all Americans in this age group 3.5 million were between the ages of 45 and 54, representing about 8% of all Americans in this age group 2.9 million were between the ages of 55 and 64, representing about 8.5% of all Americans in this age group 3.6 million were over the age of 65, representing about 9.4% of all Americans in this age group The Census Bureau issues the report annually as part of its Current Population Reports on consumer income. It includes data on income, poverty, and health insurance coverage based on information collected in the March 2010 and earlier Current Population Survey Annual Social and Economic Supplements. The survey includes a sample of 100,000 addresses in the 50 states and District of Columbia. Residents of Puerto Rico and the U.S. Virgin Islands are not represented. The researchers noted that although the median household income in 2009 (about $49,777) was not statistically different from the 2008 median, the poverty rate increased, from 13.2% in 2008 to 14.3% in 2009. Additionally, the uninsured rate and the number of people without health insurance increased between 2008 and 2009. A link to the full text of “Income, Poverty, and Health Insurance Coverage in the United States: 2009” may be found in The OPEN MINDS Circle Library at http://www.openminds.com/circlehome/eprint/indres/090110povertyreport.htm. For more information, contact: Mike Bergman, Director, Public Information Office, U.S. Census Bureau, 4600 Silver Hill Road, Washington, District of Columbia 20233; 301-763-3030; Fax: 301-457-3670; E-mail: firstname.lastname@example.org; Web site: http://www.census.govFor better or worse, the change on Nostrand is going to make the change on Franklin look minor.
WhyNot, I submit that you were stacking the deck by your references to "Grandma" and end-of-life care. What about the kids... and the young mothers... who suffer from cancer? Should they be subject to a lifetime maximum health care expenditure? Should they be cut off from further medical care when the treatment for their cancer (or other diseases) exceeds the prescribed maximum? Are you ready to kill children or people in their 20's or 30's, by denying them medical care? What about Mrs. WhyNot, if she got horribly sick?
Stacking the deck? I'm not looking to win this conversation, merely get out alive. There is a soft spot in my heart for grandmothers, kids, young mothers, and Mrs. Whynot. ....I'd prefer it if we had ample, free, quality care for all of them. ....but as our technology advances, and our ability to keep folks alive grows, this will all grow incredibily more expensive. Everyone, of course, would want a waiver of any benefit caps for their loved ones, grandma, wife, kids, you name it. I'd be in that line for waivers right there with them. .....currently the lifetime limits are the purview of the private insurance companies, once you exhaust those benefits and your resources, you end up on Medicaid. As the process of insuring everyone moves forward, it will quickly fall to something that may look a lot like the current version of medicaid. While I have no idea how we are going to pay all this, I also don't want to be the one who has to tell the family that the "care limit" for their love one has been exhausted. I'm for universal, limitless health care as much as everyone else, but "How the heck are we going to pay for all this?" ....are we simply going to keep giving out care because no one has the guts or authority to say "no". ....is anyone who suggests that someone should set such a limit automatically evil? (If "yes", is there a rehab I can check into to achieve recovery and redemption?)For better or worse, the change on Nostrand is going to make the change on Franklin look minor.
I know everyone wants there to be an easy solution, but there isn't one --whynot_31 NYAPRS Note: The following comes courtesy of Medicaid Matters, on whose Steering Committee NYAPRS is represented. MM’s Lara Kassel writes “Governor Paterson has issued the following statement in response to gubernatorial candidate Carl Paladino’s proposal to cut $20 billion from New York’s Medicaid program, (partly)…by eliminating optional Medicaid services, which we vehemently oppose. The Governor’s statement adamantly and strongly rejects the Paladino campaign’s assertions that massive, drastic cuts to Medicaid will fix New York’s deficit problem. The Governor backs up his arguments with clear facts and he reminds us of the state’s responsibility to support people in need. While we haven’t always agreed with this administration on everything, and some proposals have seemed contrary to its stated goals, we can applaud Governor Paterson for holding firm to the ideal of keeping Medicaid benefits intact and ensuring access to what all New Yorkers deserve. News from New York State Office of the Governor Statement from Governor David A. Paterson ALBANY, NY (10/07/2010)(readMedia)-- "These are difficult times in New York. Over the past two years, we have faced perhaps the most significant economic and budgetary crisis in our State's history. I have been forced to make countless difficult decisions to close more than $42 billion in deficit. And while I am proud of the work my administration has accomplished, I also know that on January 1, 2011, many of these same problems will not miraculously disappear. The next governor will be forced to close another $37.2 billion in deficit over the next three fiscal years. "I believe it is essential that the public be provided with a clear understanding of how serious our fiscal crisis is, what we can do about it, and what responsibilities government has at this time. But one candidate is suggesting he will 'cut $20 billion from the Medicaid budget in the first months' of his administration, which satisfies none of these goals. "Stripped of rhetoric, his website offers only these details to achieve $20 billion in savings: reduce Medicaid spending to 'California levels' by 'eliminating optional programs.' He says he will achieve the full $20 billion in cuts through reduction in 'gold-plated' optional benefits and by 'attacking waste, fraud and abuse in the system.' "While a massive reduction in Medicaid spending might make for intriguing campaign rhetoric, I firmly believe that a Governor has the responsibility to pursue real reforms that achieve significant savings without decimating New York's health care system and jeopardizing the lives of Medicaid recipients. Furthermore, any cuts in Medicaid spending will need to be balanced with the duty to uphold the New York constitution. Article XVII compels the governor to provide 'The aid, care and support of the needy,' and 'the protection and promotion of the health of the inhabitants of the State.' Ignoring the fuzzy math for a moment, this particular policy on Medicaid seems to be in direct conflict with the spirit of this provision in the Constitution, is almost certainly impossible to achieve, and probably violates State and Federal law. "Due in large part to the recession, more than 700,000 New Yorkers have been added to our Medicaid caseload since Spring 2008, at a cost of approximately $3 billion to the State budget. Total Medicaid spending in the 2010-11 budget is projected to be $52.6 billion. Of this, $31.1 billion is Federal matching funding, $7.3 billion is the local government share and New York State will spend approximately $14.2 billion. I am glad that this candidate is not suggesting we can achieve $20 billion in State share savings alone, as this would represent all of New York's projected 2010-11 Medicaid program spending. If that was the plan – and we only found out this week that it is not – New York would no longer have a Medicaid program because the State would be disqualified by the Federal government and lose all Federal funding. In this scenario, nearly five million people – roughly one in four New Yorkers – would lose their health insurance. "However, his claim that we can achieve $20 billion in savings by reducing New York's Optional Medicaid Services programs is equally dubious. The Federal government requires states cover 13 mandatory categories of service under Medicaid, and a state may choose to provide up to 36 specified optional services. New York provides 31. Fourteen states provide more optional services than New York, with another six providing the same amount. Twenty-one states provide between 25 and 30 of these optional services. Until last year, the aforementioned California offered 30; one less than New York. No state provides fewer than 12. "In Federal Fiscal Year 2009, more than $13 billion was spent in New York on these optional Medicaid services, including providing aid to buy prescription medicine ($4.1 billion), personal care ($2.3 billion), non-hospital based health clinics ($1.2 billion); and intermediate care facilities for the developmentally disabled ($3.3 billion). Even if New York were to eliminate all optional Medicaid services, it would not achieve $20 billion in savings. To actually achieve $20 billion in savings, New York would have to significantly scale back or eliminate categories of mandatory Federal services, which again would result in State disqualification from the entire Medicaid program. "The damage to New York's health care system and the delivery of health care would be staggering. A $20 billion reduction would represent a $4.8 billion (10.2 percent) reduction in hospital industry revenues; a $2.6 billion (22.9 percent) reduction in nursing home revenues; a $2 billion (36.5 percent) reduction in home care/personal care industry revenues; and a $3.6 billion reduction in support for services to the mentally ill and developmentally disabled. Medicaid funding currently supports virtually every hospital – approximately 220 of them – and provides the majority of funding to the 636 nursing homes in New York. The economic impact of this proposed cut would be equally debilitating, as these health care providers employ nearly 1 million New Yorkers. Cuts in health care services would disproportionately affect the approximately 1.75 million children, 725,000 blind and disabled and 415,000 seniors who currently get some form of Medicaid assistance. "The consequences of his proposal would significantly outweigh any savings to the State budget, and in all probability would actually increase State spending by driving New Yorkers from less costly preventative care to expensive emergency services. If this plan was taken seriously and followed to conclusion, dozens of hospitals and hundreds of nursing homes would close, hundreds of thousands of New Yorkers would lose their jobs, and millions of New Yorkers would lose access to affordable medication. Simply put, this plan would jeopardize the health and safety of millions of New Yorkers. "During my tenure as Governor, I have held the line on the rate of cost escalation for health care providers and managed care plans; implemented reimbursement reforms to right-size hospital inpatient reimbursement; made investments in critically needed, less costly outpatient and primary care services; and implemented measures to make New York Medicaid a smarter purchaser of prescription drugs and transportation services for patients. I also secured changes that will rationalize the way nursing homes are paid. I advanced reforms so that New York will no longer pay for 'never events' like leaving in a sponge after surgery, potentially preventable readmissions to hospitals and unnecessary hospitalization of nursing home patients. Together, these measures have saved the State $4.65 billion. As we made these critical reforms, we also streamlined public program eligibility processes to ensure that eligible uninsured New Yorkers could get the health care services they need. "Although I firmly believe more savings can and must be achieved in the Medicaid program, it is imperative that the State takes a sensible approach to reforming this vital program. In my 2010-11 budget, I proposed $726 million in responsible Medicaid cuts that would have reduced costs to the State in this fiscal year and into the future. Proposals that would have ensured appropriate use of personal care services, rationalized reimbursement for home care services, strengthened Medicaid's ability to recover from estates and further reduced prescription drug costs were rejected by the Legislature. In my 2009-10 budget, similar proposals that would have saved the State $545 million were likewise rejected by the Legislature. "New Yorkers deserve an intellectual discussion based on facts, not ignorant sound bites designed to mislead the public."For better or worse, the change on Nostrand is going to make the change on Franklin look minor.
So, if we don't implement Obamacare, do we simply all end up poor and on medicaid by default? ....or is the world ruled by those lucky enough to never get sick? http://www.demos.org/event_list.cfm?currenteventid=A78DFACD%2D3FF4%2D6C82%2D56EEC77216824F69For better or worse, the change on Nostrand is going to make the change on Franklin look minor.
I haven't read anything in here but I see two fundamental problems with healthcare I pay the same insurance premiums as the people in my company in worse health My company pays a couple thousand dollars a year to give me insurance that I use for nothing more than an annual check up that would cost about $200 out of pocket And once you open the entitlement floodgates, like a leak in a dam that ends up destroying it, it's difficult + will take a long time to close it + correct all the damage (if that's even possible) Again I'm no expert on healthcare by any means... I don't have any solutions.... but at the surface, at least, there seem to be some pretty obvious problems that should be addressed before piling on more entitlement[
I <3 CTK
Cool The Kid » I pay the same insurance premiums as the people in my company in worse healthBut that's part of the idea of insurance. Everyone pools resources together to get the widest coverage possible (in theory). If we didn't do it this way, health insurance would basically be unaffordable for people with health problems. Also, god forbid, if you become one of these unhealthy people, you won't face completely unaffordable coverage, left to die of cancer without any treatment whatsoever while going completely broke. I'm not describing this theory very accurately, as it's not a straightfoward "spread the wealth" kind of thing
Cool The Kid » My company pays a couple thousand dollars a year to give me insurance that I use for nothing more than an annual check up that would cost about $200 out of pocketBut that's part of the idea of insurance. Coverage against catastrophic incidents. Also, part of the idea of health care reform was to dramatically reduce runaway costs. Unfortunately though Obama passed a health insurance plan, not a health care plan.
Cool The Kid » Again I'm no expert on healthcare by any means... I don't have any solutions.... but at the surface, at least, there seem to be some pretty obvious problems that should be addressed before piling on more entitlementSimply expanding coverage, at all costs, to people who can't afford it isn't the central goal of health care reform. It's not a simple expansion of entitlements. It's far more comprehensive. Health care reform should/will dramatically reduce the wildly inflated costs, making it more affordable for everyone, and thereby expanding access. It also does very practical things like prevent health care companies from letting you pay premiums for years, and then get dumped the minute you get sick. The Health Insurance Industry has many practices that are morally reprehensible, and since you're talking about people's health and going broke b/c of it, it is an industry that needs strict regulation.
Boygabriel » Simply expanding coverage, at all costs, to people who can't afford it isn't the central goal of health care reform. It's not a simple expansion of entitlements. It's far more comprehensive. Health care reform should/will dramatically reduce the wildly inflated costs, making it more affordable for everyone, and thereby expanding access. It also does very practical things like prevent health care companies from letting you pay premiums for years, and then get dumped the minute you get sick. The Health Insurance Industry has many practices that are morally reprehensible, and since you're talking about people's health and going broke b/c of it, it is an industry that needs strict regulation.I completely agree. ...but while we wait for all of this to occur, people are being bankrupt by their uncovered costs, or going without insurance due to its costs. Much of this is due to Obama's (the country's?) failure to have a "public option" implemented. As a result, folks are ending up on Medicaid. ....an expensive program with no caps, and very little oversight is becoming the Public Option ...and it isn't pretty. You see all those stories about medicaid and medicare fraud in the newspaper? Those criminals have the guts to commit such crimes because they feel there is very little chance of being caught. ....you see far fewer stories in the paper regarding people defrauding private insurance companies, largely because it is much harder.For better or worse, the change on Nostrand is going to make the change on Franklin look minor.
Today's example, and amatuer analysis: By allowing CHP insurance companies to not cover Autism (a very expensive condition), the government is forcing those able to pay to use their own resources. As a result, if you don't have resources, or have exhausted your resources, you end up on Medicaid. The state did this because the feds pay for a greater portion of Medicaid than CHP AND it forces those able to pay to do so before it has to pick up the tab. .....Boygabriel is correct, the current economic and fiscal climate does not allow governments to haphazardly expand benefits. The insurance companies are too powerful to allow this to happen.
Governor Vetoes Bill To Mandate Autism Health-Insurance Coverage By Cara Matthews Politics on the Hudson October 21, 2010 Gov. David Paterson has vetoed legislation that would require state-regulated health-insurance companies to cover “evidence-based, peer-reviewed and clinically proven” treatment and therapy for people with autism spectrum disorder, saying it would amount to an unfunded mandate because it would increase health-insurance premiums state and local governments pay and the premiums for Child Health Plus, a government insurance program for children whose families are not eligible for Medicaid. The total annual cost of the legislation could be $70 million, according to the governor, and the state budget does not include money to pay for that. The cost of commercial health insurance would also grow if the legislation were implemented, and could lead to loss of coverage for some New Yorkers, he said in the veto. The state has a number of programs that provide early intervention for children with autism and other developmental disorders, although many families have to pay a significant amount of money each year to get all the services they believe their children need. Paterson, who has about two months left in his term, wrote that he is “extremely sympathetic to the very real struggles faced by families of individuals” with autism spectrum disorder, which he said is a priority for society to address. Autism spectrum disorder, which occurs in roughly one out of every 100 kids, is characterized by difficulty with speech and social interaction and repetitive behavior patterns. Symptoms vary depending on where children are on the spectrum. “It will be a subject of my continued advocacy as a private citizen. But now I am governor, and I cannot sign a bill that would impose costs that the Legislature does not fund,” Paterson wrote. The bill has been the subject of intense lobbying by autism advocates who support and those who oppose the legislation. It was sponsored by Sen. Neil Breslin, D-Delmar, Albany County, and Assemblyman Joseph Morelle, D-Irondequoit, Monroe County. Opponents said it would hurt people seeking treatment for autism because of the “evidence-based, clinically proven and peer-reviewed” standard, which is not required for other medical problems, and would shift costs from insurance companies to counties and taxpayers for early intervention services. Sen. Craig Johnson, D-Nassau County, said he was disappointed the governor vetoed the bill and said the Legislature should reconvene to consider an override. This is part of a statement he released: “I believe the governor’s decision to veto legislation requiring health insurance companies to cover some of the costs associated with autism is a giant, misguided step backwards. I wish Governor Paterson, prior to rendering his decision, spent some time with parents who have to work second jobs and have taken out third mortgages in order to provide their children with much-needed autism-related therapies. Health insurance companies have a responsibility to be there when our families are in need. Governor Paterson’s actions today have unfortunately made it easier for them not to honor this commitment.” The governor said another flaw in the autism bill is it would require the state Health and Insurance departments and a few other state agencies to develop regulations for health insurers within a year and update them regularly, but the state budget does not provide them with the extra resources they would need to do this.” http://statepolitics.lohudblogs.com/2010/10/21/governor-vetoes-bill-to-mandate-autism-health-insurance-coverage/#more-11166For better or worse, the change on Nostrand is going to make the change on Franklin look minor.
(more fighting!) NY Governor Candidates Seek Medicaid Spending Trim By Michael Gormley, Associated Press October 25, 2010 ALBANY, N.Y. – New York's major candidates for governor shared their ideas Monday for letting some air out of the Medicaid balloon in New York, which spends more on the federal health care program for low-income people than Texas, Florida and Michigan combined. Republican Carl Paladino released a plan Monday that he said would reduce New York's "gold-plated" system to be more in line with other states. He promises a $20 billion cut in the $52 billion program. Democrat Andrew Cuomo said in Buffalo that he will work with the health care interests to reduce the "unsustainable" level of spending and would target inefficiencies and fraud. If the health care providers don't cooperate — they've opposed past efforts — Cuomo threatened to simply cut spending. New York's Medicaid program has grown from government health care for those on welfare to encompass millions more poor and working poor. Nearly one in four New Yorkers receive Medicaid services. Over the years, lawmakers lobbied by powerful special interests, including hospitals and health care worker unions, have added optional coverage benefits to a program that has long been called the "Cadillac" of state systems. In 2008, the most recent year of available comparisons, more populous California spent $10 billion less than New York on Medicaid. New York spent more than Texas, Florida and Michigan in total, according to the Kaiser Family Foundation. Lt. Gov. Richard Ravitch, a widely respected expert on fiscal crises, issued a study last month that found the unwieldy system serves "contradictory goals and provides perverse incentives" and is "ill-equipped to control costs." E.J. McMahon of the fiscally conservative Empire Center for New York State Policy said the state is already scheduled for a big cut when federal stimulus money runs out next year. That will create an immediate 20 percent reduction in funds, he said, while Medicaid inflation and the rising number of recipients are increasing costs 8 percent a year. "Paladino deserves credit for recognizing that you can't reduce Medicaid costs unless you are willing to reduce the number of people eligible for Medicaid and reduce the array of services to which Medicaid-eligibles are entitled," McMahon said Monday. Paladino's goal of cutting $20 billion immediately is implausible, he said, but his plan could save a lot of money over the course of years. Paladino called Medicaid "probably the single biggest cause of New York's stagnant economy." The $52 billion cost is part of a $135 billion state budget that increased taxes and spending over the past two years. He said his cuts would save state and local property taxpayers $10 billion in the first year. Paladino said the cut in the county contribution to Medicaid will allow for reductions in county taxes of more than 30 percent. McMahon called Cuomo's plan "very vague and general." "Cuomo's solution — 'make Medicaid more efficient' through various administrative reforms — is simply inadequate," McMahon stated in a review of the two proposals. "We have the highest rate in the nation, and it is just not sustainable," Cuomo said Monday at the Roswell Park Cancer Institute. He wouldn't detail any cuts but said he would "redesign the entire program," which he considers "fundamentally flawed." He said he would also take over administration from the counties. And he said he would bring in the health care special interests that have pushed the Legislature to drive up the cost. "I want to bring in the providers," Cuomo said. "I want to bring in people who are actually doing business with the state and say, 'Guys, we can't afford it anymore. We have to reduce the amount we spend on Medicaid; let's redesign the program together.' "Otherwise," he added, "I'm just going to have to cut off the top, and that's not the best way to do it." Associated Press writer Carolyn Thompson in Buffalo contributed to this report. http://news.yahoo.com/s/ap/20101025/ap_on_el_gu/us_ny_governor_s_race_medicaid/print ------------- Medicaid Crackdown Paying Off By Carl Campanile New York Post October 25, 2010 The number of suspected Medicaid-fraud cases handled by state investigators -- ranging from dirty dentists and druggists to millionaires illegally on the dole -- more than doubled last year, according to an explosive new report. The state Office of Medicaid Inspector General referred 208 cases to Attorney General Andrew Cuomo's office for potential criminal prosecution of health-care providers -- a 136 percent increase from 2008. Meanwhile, the number of suspected cases of Medicaid-patient fraud referred to local prosecutors also skyrocketed. For example, the number of suspected forgeries tied to the diversion of prescription drugs jumped from 304 to 683. Overall, the number of substantiated fraud cases involving Medicaid patients increased 50 percent, the report said. A total of 552 cases were referred to New York City investigators for potential prosecution, the report said. Medicaid Inspector General James Sheehan attributed the surge in cases to an overhaul of his office the last few years that included an increase in the number of undercover investigative staffers and auditors and the use of a new, more sophisticated, data-mining system that flags suspected problems. "It's better detection, and more people on the street means more cases. We have the resources and trained people. We're finding the cases," Sheehan said. "We are also getting a lot more reports [of fraud, waste and abuse] from the public and more disclosure from providers. People know we're looking," he said. But one state lawmaker said investigators were just scratching the surface of Medicaid fraud. State Sen. Marty Golden (R-Brooklyn) said OMIG's done a much better job of auditing health-care providers to recoup money from billing mistakes than nabbing fraudsters. "The inspector general has to put more investigators in the street. We're spending $1 billion a week on Medicaid. Let's get real," said Golden. Sheehan said the state recouped more than $500 million last year from Medicaid fraud, waste and abuses -- thanks largely to prosecution by Cuomo's office. He said OMIG helped save $1.6 billion overall through audits and cost-prevention measures. New York spends about $52 billion on Medicaid. http://www.nypost.com/f/print/news/local/medicaid_crackdown_paying_off_QYiNo9jzsSvZsBcclKYKRNFor better or worse, the change on Nostrand is going to make the change on Franklin look minor.
moreFor better or worse, the change on Nostrand is going to make the change on Franklin look minor.
Cutting Medicaid To Curb Debt Won't Be Easy
by Elizabeth Moore Newsday December 11, 2010
WHATEVER Governor-elect Andrew Cuomo decides to do to close New York's multibillion-dollar Medicaid gap, he'd better be ready to deal with New Yorkers like Geraldine Flynn.
"I fight for everything I need," said Flynn, 55, who has cerebral palsy and uses a wheelchair. Medicaid pays for 24-hour-a-day home health aides for Flynn and for the complicated medical care she needs. It pays monthly rent so she can remain in the family home in Point Lookout while her ailing 88-year-old mother resides in a nearby assisted living center. And it just bought Flynn a new power chair.
"Doesn't mean you get away with anything," said Flynn, who will be moved to Section 8 housing after her mother dies. "Some people think I've got it easy - I don't."
Trouble is, New York State hasn't got it easy these days either.
With federal stimulus aid set to expire next year, intense scrutiny is being trained on the largest single expense driving the budget off a $9.3-billion cliff: Medicaid, on which New York spends twice as much per capita as the rest of the country. Spending on care like Flynn's is soaring even though fewer people are receiving it, noted the Citizens Budget Commission: The cost of caring for a nursing-home patient has gone up 19 percent in the past five years, while personal care services cost 40 percent more and the per-patient cost for certified home health agencies is up 76 percent.
Call For A Redesign
Cuomo, who has vowed not to increase taxes, wants to trim the cost of Medicaid by reorganizing it to eliminate waste and focus spending in ways that really improve health.
"We haven't redesigned the Medicaid program in decades in this state, and now it's time," he told Newsday at an October campaign stop in upstate Delhi.
That's a tall order. New York has the nation's most expansive safety net, one that covers far more services than federal rules require and now stretches to cover 4.7 million people - nearly one in four state residents.
Half of all the babies born in the state are covered by Medicaid. So are three quarters of all nursing home stays. The program not only serves welfare recipients, the disabled and childless indigent adults, but also insures low-income working families, with sliding-scale coverage for children from families earning up to $88,000. And it reimburses hospitals that care for the uninsured. The recession of 2008 and 2009 drove 600,000 people onto the rolls, and federal health care reform is expected to add many more.
"I don't blame people for taking advantage of a program that is available to them," said Lt. Gov. Richard Ravitch, who this fall issued proposals for reform. "I fault all the expansions of Medicaid and child health care that occurred without the government being willing to tax to pay for it . . . The course we're on is not sustainable."
A System With 'Contradictory Goals'
New York's system, created in the 1960s for welfare clients, is saddled with "an unwieldy and overly decentralized structure that serves contradictory goals and provides perverse incentives," Ravitch wrote.
It is the counties that determine who is eligible for Medicaid, but a jumble of different state agencies oversees the various things it pays for - and the legislature controls reimbursement rates, the subject of perennial haggling that helps keep a small army of Albany lobbyists employed.
Lawmakers have made plain they don't intend to give up their rate-setting power. Hospitals, which have seen provider reimbursement rates cut nine times since 2007, warn some of them could go under if those rates drop again. Medical malpractice reform, another long-sought source of savings, has gone nowhere. For now, saving money by reducing eligibility or services is blocked by a moratorium in the federal health care reforms.
Still, "The severity of the state's shortfall is so large that I think more basic questions than we've ever asked have to come to the forefront now," said Sen. Kemp Hannon (R-Garden City).
Cuomo says he'd like to see New York imitate Wisconsin, which last year let health officials and stakeholders decide how to trim 10 percent of the Medicaid budget without reducing care. Those changes, like ending unnecessary Caesarean sections, were accepted by the public with little controversy.
Already the politically powerful health care union 1199 SEIU United Health Care Workers East has begun talks with Cuomo on a proposal it promises will bring "significant savings" by changing the payment model for home health care to predetermined bundles of care based on need, rather than reimbursing providers by the hour.
"The hospital and nursing-home industries are in dire financial condition," warned 1199's political director, Kevin Finnegan. "Any changes . . . have to be dealt with very gingerly."
But Vincent J. Russo, the attorney who helps Flynn with her Medicaid, called the talks in Albany "very concerning. We're seeing difficulty with clients accessing the Medicaid home-care program, and limitations on what they are going to be able to receive."
"I get worried," agreed Peter Belmonte, an airfreight dispatcher whose 85-year-old father was felled by two strokes and has lived for the past seven years in a nursing home on Medicaid. Belmonte's father, a former iron worker who is fed through a tube, is visited daily by his 83-year-old wife, a retired seamstress who remains at the couple's Valley Stream home, living on their pensions and Social Security. Their home was placed in trust to Belmonte and his sister so they can keep it after she dies, rather than having to sell it to pay off Medicaid.
Belmonte doesn't want to see any of these kinds of benefits touched as Cuomo seeks to address the Medicaid budget crisis - a mess Belmonte blames on "poor management."
"We've got a new governor, and I hope he does something about it. If not, he'll have to go too, in four years."For better or worse, the change on Nostrand is going to make the change on Franklin look minor.
"I fault all the expansions of Medicaid and child health care that occurred without the government being willing to tax to pay for it . . . The course we're on is not sustainable."
funny how that works.
newspaper » "I fault all the expansions of Medicaid and child health care that occurred without the government being willing to tax to pay for it . . . The course we're on is not sustainable."
BG » funny how that works.
But such a course is often charted by people of both parties who want to be re-elected or elected.
"If you elect me class president, I will eliminate homework, make ice cream free, and have more snow days"For better or worse, the change on Nostrand is going to make the change on Franklin look minor.
Yea! WhyNot for President!! Free ice cream!!!
....campaign donations are now being accepted.
P.S. Like Bloomberg, I'm an independent.For better or worse, the change on Nostrand is going to make the change on Franklin look minor.
But such a course is often charted by people of both parties who want to be re-elected or elected.
"If you elect me class president, I will eliminate homework, make ice cream free, and have more snow days"
No question about it.
Like I said elsewhere, Americans have a pathological dislike of government and taxes, in lieu of a more rational practical approach to political, economic and social realities.
Maybe I'll try to become a benevolent dictator as a resultFor better or worse, the change on Nostrand is going to make the change on Franklin look minor.
The Painful Price of Medicaid
A Center for New York City Affairs forum.
WEDNESDAY, APRIL 6, 2011
5:30 PM – 7:15 PM
65 WEST 11TH STREET (BETWEEN FIFTH AND SIXTH AVENUES), 5TH FLOOR
The fast-rising cost of Medicaid is one the most pressing issues facing the governments of New York City and State. One in four New Yorkers are served by the system of insurance, which now costs an average of $1 billion a week. Health care for the poor and long term care for the disabled and older people are more expensive than ever--and their recent growth exceeds the size of the state's budget gap. Governor Andrew Cuomo's new Medicaid Redesign Team made recommendations that would create nearly $3 billion in savings. With those recommendations now public, what is the future of Medicaid in New York? And what are the implications for New York City's families?
Jason Helgerson, Medicaid Director, State of New York
Commissioner Robert Doar, NYC Human Resources Administration
Followed by a conversation with:
Alyssa Aguilera, Community Organizer, New York Lawyers for the Public Interest
Elizabeth Lynam, Vice President, Citizens Budget Commission
Moderated by: Anemona Hartocollis, Reporter, The New York Times
Admission is free but you must reserve a seat. Please email email@example.com or call 212.229.5418.
Supported by the Sirus Fund and the Milano FoundationFor better or worse, the change on Nostrand is going to make the change on Franklin look minor.
Do Not Tinker With Medicaid! Most Americans Say
Written by Christian Nordqvist Medical News Today May 25, 2011
The majority of Americans do not want to see any reductions in Medicaid spending and are against the proposed plan to convert the health program to block grant financing in an attempt to reduce the federal deficit, according to a May Kaiser Health Tracking Poll, involving a nationally representative random sample of 1,203 adults.
60% of all the people surveyed want Medicaid to remain as it is - with guaranteed coverage from the federal government and minimum standards set for eligibility and benefits. 35% would like to see states receiving a fixed amount of money from the federal government, with each state deciding what services should be covered and who is covered.
Just 13% favor reducing Medicaid spending to bring the deficit down. While 30% say they would accept minor reduction, 53% are against any reductions whatsoever.
These poll results may encourage some Washington politicians and discourage others. Washington is in the middle of a fierce debate about Medicare and Medicaid - in fact, any entitlement program is currently under the microscope as a possible avenue for saving money.
Approximately half of all US citizens either have a household member or friend who has received Medicaid assistance. Half of those surveyed see Medicaid as important to their family. 20% of adults have had personal coverage experience with Medicaid and they say they are happy with it.
Kaiser President and CEO Drew Altman, said: "If you watch the debate about the deficit and entitlements, you would think that almost everyone has a problem with the Medicaid program and wants to change it, or cut it - or both. The big surprise in this month's tracking poll is that one group who does not want to cut Medicaid is the American people. With about 69 million people expected to be covered by Medicaid this year, it is no longer the -welfare-linked program it once was. Medicaid may not be the lower-hanging fruit that many who want to reduce federal entitlement spending have assumed it is."
51% of all Americans say they have some personal connection to Medicaid
20% have received direct Medicaid help
31% say they have a friend or family member who has received Medicaid assistance
49% describe Medicaid as "very" or "somewhat" important to them and their family
71% of those who favor Medicaid say their main reason is, knowing there is a safety net to protect those on low income. Others feel encouraged knowing that Medicaid is there in case they or a family member need the assistance.
Mollyann Brodie, a senior vice president and director of the Public Opinion and Survey Research group at the Kaiser Family Foundation, said: "Medicaid is a complex program that varies considerably from state to state, but the public's initial reaction upon hearing about proposed spending reductions and structural changes is negative. Such concerns reflect the fact that the program is important not only to those who have been directly enrolled in it but those with friends and family who have received Medicaid benefits as well."
Medicaid and Private Insurance Personal Experience Ratings
86% of recipients of Medicaid benefits describe their experience as "positive"
45% of recipients of Medicaid benefits describe their experience as "very positive"
89% of private health insurance users describe their experience as "positive"
44% of private health insurance users describe their experience as "very positive"
Under the Patient Protection and Affordable Care Act, Medicaid is set to expand. 81% of respondents said that if they were uninsured, needed medical therapy and had no insurance, and also qualified for Medicaid, they would enroll.
However, some 32% of those who have ever used Medicaid said that at some point, finding a doctor or health care provider willing to accept Medicaid patients was difficult, versus 12% among those with private insurance cover.For better or worse, the change on Nostrand is going to make the change on Franklin look minor.
In NYC, 1/3 of residents now receive Medicaid
City Medicaid Near Critical Condition
By David Seifman New York Post August 31, 2011
The number of city residents qualifying for Medicaid has hit a record that's likely to go even higher next year when enrollment will almost certainly reach the milestone 3 million mark -- or more than 37 percent of the population, officials said yesterday.
As of July, a record 2,927,952 people here were getting their health insurance covered by the government. Although the numbers fluctuate slightly from month to month, the annual trend is headed in one direction: up.
Five years ago, in July 2006, the city's Medicaid rolls stood at 2,573,610.
Robert Doar, commissioner of the city's Human Resources Administration, which oversees Medicaid, said the steady increases are evidence that low-income workers are becoming dependent on the government for medical insurance as more and more employers drop health coverage.
"The use of Medicaid as a work support for low-income workers is very much a part of what's going on in the city and the rest of the country as well," Doar said. "We think it's an important expenditure. It allows people to take employment that doesn't provide health insurance."
But only those with very low incomes can make the cut. The maximum allowable net income for a family of four is $17,420 a year.
Medicaid is no longer the crushing financial burden it once was for the city.
Until five years ago, the feds paid 50 percent of the bill, with the state and city splitting the rest down the middle.
Starting in 2006, the state capped most of the city's Medicaid cost at 2005 levels, plus a yearly inflation adjustment of about 3 percent.
Washington also began picking up a larger part of the tab in late 2008, as part of a federal stimulus package that largely expired in June.
As a result, total Medicaid spending in fiscal 2011 came to $28.3 billion in New York City. Washington paid $13.5 billion, the state $10.2 billion and the city $4.6 billion, or little more than 16 percent.
But as federal subsidies wind down, the city's bill in the 2012 fiscal year is expected to reach $6 billion.
Chuck Brecher at the Citizens Budget Commission noted that the revised formula makes the growing Medicaid rolls a fiscal problem more for the state than the city.
"It's the state that's the one getting the squeeze put on," he said.
It's also much easier to qualify for Medicaid than for welfare, in which recipients are required under federal law to work for their benefits.
As the Medicaid rolls jumped 15,266 between June and July to their highest level ever, the welfare rolls fell to 347,586, lowest since August 2010.
Doar is on a state panel examining how to redesign the Medicaid system. He said one issue under discussion is whether the state or city should screen applicants.
"To the extent that we no longer determine eligibility, the argument could be made, why are we paying any portion of the cost," said Doar.For better or worse, the change on Nostrand is going to make the change on Franklin look minor.
Medicare is a different issue.For better or worse, the change on Nostrand is going to make the change on Franklin look minor.
NY State Gov to towns and cities: Sorry, we won't pick up your share of medicaid.For better or worse, the change on Nostrand is going to make the change on Franklin look minor.
Pending health care reimbursement changes held the potential of getting rid of the weakest hospitals and most inefficient providers.
...not if they merge into a few big providers.For better or worse, the change on Nostrand is going to make the change on Franklin look minor.
In a desperate attempt to control costs, the state implements Health Homes.
Medicaid 'Health Homes' Not Built
Schenectady, Saratoga Counties Await State Action As Networks Begin To End Fee-For-Service Care
By Cathleen Crowley Albany Times Union October 26, 2011
On Jan. 1, the state's Medicaid system will start moving into a new model of care. But as one Department of Health official said, describing it is like trying to explain a world inside Dungeons and Dragons: It doesn't really exist.
Schenectady and Saratoga counties are among the first counties that, starting Jan. 1, are supposed to enroll Medicaid patients into "health homes," or networks that will manage the care of a Medicaid patient. The state has yet to designate the counties' health homes, or set details of how they will run.
Many providers are overwhelmed by how fast the state is changing policies, and fear that patients will slip through the cracks. Organizations are scrambling to partner and form health homes. Even though the start date is Jan. 1, state officials said it will be an evolving process that will take years and enrollment will happen gradually as health homes get up and running.
Health homes are not brick-and-mortar structures, but networks of local providers that will share the responsibility of caring for each Medicaid patient they enroll, including physical, mental health and addiction needs. Most networks will be led by a hospital, a community health organization or an insurance company.
For example, the Visiting Nurses Association of Schenectady and Saratoga Counties is the lead agency in a proposed network that includes Ellis Medicine, Hometown Health Centers, CDPHP and MVP Healthcare.
State leaders believe that coordinated care will be cheaper and better compared to the scattered fee-for service care Medicaid patients currently receive.
"There are probably a bunch of people here mourning the loss of fee-for-service," said Michael Hogan, commissioner of the state Office of Mental Health, referring to the previously dominant model. "But get over that. We are not going back there."
Over the next several years, state leaders hope to move all five million Medicaid recipients into managed care. The early focus will be on high-cost, high-need patients, including 150,000 Medicaid patients who account for $7 billion in Medicaid spending.
Medicaid patients will be assigned to health homes, but they have the right to opt out or choose another network, said Greg Allen, director of the state Department of Health's financial planning office.
Health homes will receive incentive bonuses for keeping their members healthy. The state expects to save $33 million in Medicaid expenditures in the first year by reducing hospitalizations and ER visits.
More than 300 providers and mental health advocates spent Wednesday morning learning about health homes at the annual conference of the Mental Health Association in New York State held at the Albany Marriott.
Speakers at the event encouraged the audience to embrace the changes.
"This is our chance to get it right for patients who have multiple chronic illness or mental health illness," Allen said.
Many organizations have filed letters of intent with the state indicating they plan to form a home health network. The state plans to approve a few networks in each community. Here is a look at some of the lead organizations that have filed letters in the Capital Region, along with a sampling of their partners. The full list is available on the Department of Health website.
Making the List
· Visiting Nurses Association of Schenectady and Saratoga County with Ellis Medicine, Hometown Health Centers, CDPHP and MVP Healthcare.
· Glens Falls Hospital with Adirondack Medical Services, Hudson Headwaters Health Network and Saratoga Hospital.
· Samaritan Hospital Behavioral Health Services with the Rensselaer County Department of Mental Health, Northeast Health Primary Care Network and Seton Primary Care.
· Whitney M. Young Jr. Health Center with Albany Medical Center, St. Peter's Health Partners, CDPHP and Fidelis.
· AIDS Council of Northeastern NY with Albany Medical College's AIDS Treatment Center, Hudson Headwaters, Clearview Center and Four Winds Hospital.
· Belvedere Health Services with Ellis Hospital, Samaritan Behavioral Health, and Rehabilitation Support Services, Inc.
· ClearView Center with Albany County Mental Health, Albany Medical Center, and Saratoga Hospital. Rehabilitation Support Services, Inc., with Ellis Medicine, Catholic Charities AIDS Services, and Albany Medical Center.
The full list of "health homes" is available on the Department of Health website.For better or worse, the change on Nostrand is going to make the change on Franklin look minor.