As we await the Supreme Court's decision on Obamacare (aka the Affordable Care Act):
Medicaid Wars (warning: boring)
Join us for Festivus on Sunday, January 12, 2014 http://brooklynian.com/forum/the-lounge-random-stuff/save-the-date-dec-15-2013-the-9th-annual-brooklynian-festivus?replies=1#post-774296
Not coming down today.i extend my battery life by turning down the brightness
"It announced that all remaining rulings for the year will come in three days."
Wait, what? Does SCOTUS have the rest of the year off?If you're happy, you're not paying attention.
spurn Productions, Inc.
A US Supreme Court Term begins the first Monday in October and ends the first Monday in October of the following year.
During the year, the Justices hear cases from October through the end of April, and only take the bench to announce opinions during May and June. The Court rises at the end of June or early July after it has disposed of all the cases on its docket for the year. While the justices are out of the public view, their work continues as they prepare for the next Term.
See SCOTUS calendar HERE
The answer makes being a member of SCOTUS seem less appealing.
Meanwhile, the policy wonks wonder what should be tried next if the Supreme court strikes down Obamacare implementation and we are left with our current mess: http://www.kff.org/pullingittogether/dual-eligibles-health-reform.cfm
Like most pieces of landmark legislation (Civil Rights Act of 1964, Brown vs Board of Ed), this means it is time for the hardest work: Implementation or, um, modification.
Expansion of Medicaid seems to be something that will be left to the states. Will poor states do the federal minimum?
How The Medicaid Expansion Could Actually Save States Money
By Suzy Khimm , Washington Post Blog July 5, 2012
Republican governors opposing the Medicaid expansion have focused on the costs their states would have to take on. But there are also ways that the expansion would save state governments money, helping to offset at least some of the new upfront Medicaid costs. And in some cases, they’re likely to save states more money on Medicaid than they currently are spending.
First, many state and local governments help hospitals offset the cost of care they provide to uninsured patients who can’t pay for medical care — paying about $10.5 billion, or 18.5 percent, of the cost of uncompensated care, according to a 2008 study cited by the Urban Institute. Having more patients on Medicaid would help bring down those costs for everyone, which is why hospitals are lobbying hard for states to participate in the expansion.
Second, the Medicaid expansion would also reduce state spending on mental health services for lower-income and uninsured patients, which has also grown over time. State and local governments covered 42 percent of the cost of state mental health expenditures in 2009, totaling $16.3 billion. That covered mental health services provided by state mental hospitals, emergency ER visits and, increasingly, community health clinics.
Enrolling more state residents into Medicaid would help offset some of the spending on mental health that state and local governments are shouldering already. States will have to begin contributing to Medicaid coverage as well, starting in 2017, but they will still be matched by federal dollars at a 9:1 ratio, getting more bang for the buck on the money they do spend.
Advocates for mental health are appealing for states to join the Medicaid expansion on similar grounds. “The expansion of Medicaid also requires those who are newly eligible to receive mental health and substance use services at parity with other benefits. State participation in the Medicaid expansion is therefore critically important,” Mental Health America said in a statement after the ruling.
Overall, the savings will likely bring down the upfront costs to states of the Medicaid expansion. The Center on Budget and Policy Priorities calculates that state Medicaid spending will ultimately rise by 2.8 percent by 2022 if they join the expansion. However, that figure “actually overstates the net impact on state budgets because it does not reflect the savings that state and local governments will realize in health-care costs for the uninsured,” says CBPP spokesperson Shannon Spillane. “In fact, states could end up with a net gain.”
Without factoring in these hospital and mental health savings, only Maine, Massachusetts, and Hawaii are likely to see net savings* from participating in the Medicaid expansion, according to a report that the Urban Institute produced for the Kaiser Family Foundation. The GOP states that have opposed the expansion will pay more upfront, largely because they already have more restrictions on who can participate. But with the savings from uncompensated care and mental health, the number of states seeing net savings could rise.
New York’s Medicaid Reforms
New York Times Editorial September 17, 2012
New York State has substantially changed its Medicaid program in the past year and a half in ways likely to improve the health of its poorest residents and rein in the program’s enormous costs.
Now the state is asking the federal government to let it use $10 billion in projected federal savings from its reforms to modernize hospitals and clinics serving the poor and to expand primary and preventive care. If spent wisely, that investment could turn New York into a model on how to cut Medicaid without harming the beneficiaries.
New York’s Medicaid program, the nation’s costliest, spends more than $54 billion a year to cover some five million people, about a quarter of the state’s population. Roughly half the cost is paid by the federal government and the other half by state and local governments.
New York faces the same problem as many other states: its share of the costs of this state-federal insurance program for the poor has been rising steadily, limiting its ability to pay for other urgent needs, like education.
Last year, Gov. Andrew Cuomo, working in collaboration with health care providers and labor leaders, pushed through a budget that seems to be easing the stress. It places a cap on what the state can spend on most Medicaid programs, cuts payments to health care providers and managed care plans and sets up a mechanism to make further cuts to provider payments to stay below the cap, which, so far, has not been breached.
The cap started at $15.3 billion last year and is allowed to rise by only 4 percent a year, bringing it to $15.9 billion for the current 2012-13 budget year. The state’s total budget for Medicaid, including noncapped programs, is $20.8 billion for the current year.
The reforms do not impose higher cost-sharing on beneficiaries or make significant cuts in benefits except in a few programs, like home care visits for housekeeping services or unlimited rehabilitative services.
Most important for the long term, the budget accelerates movement from uncoordinated fee-for-service care to managed care, from high-priced specialists to primary care doctors, and from high-cost institutions to care in the community through grants, technical support and financing for health information technology. Most providers have agreed to accept lower payments in return for having a say in the reforms, rather than having them dictated by Albany. The state estimates its reforms should save the federal government $17 billion over the next five years.
The Centers for Medicare and Medicaid Services should allow New York to plow $10 billion from money the federal government will save if New York’s projections of future Medicaid savings are as plausible as they look at first glance. The agency should also look hard at New York’s plans to track and measure how well its reforms work and to obtain independent evaluations from outside experts. New York could serve as a model to other states if it can show which reforms work, which don’t, and what their combined effects are on statewide spending.
tick, tick, goes the clock
THE SECRETARY OF HEALTH AND HUMAN SERVICES
WASHINGTON, D.C. 20201
Over the past two years, we have worked together as many of you began building your new health insurance marketplaces. The hard work you have engaged in has laid the foundation for providing access to quality affordable coverage for millions of Americans. Consumers in all fifty states and the District of Columbia will have access to insurance through these new marketplaces on January 1, 2014, as scheduled, with no delays.
This Administration is committed to providing significant flexibility for building a marketplace that best meets your state's needs. We intend to issue further guidance to assist you in the very near future. Funding is now available to you no matter where you are in the process of establishing an Exchange and no matter whether you plan to run your own Exchange, partner with another state, or work with the federal government. In response to your request, we previously announced that states have until the end of2014 to apply for these federal funds and have the flexibility to use such funds both for building Exchanges and for associated start-up costs provided that a state's Exchange is not yet self-sustaining. The next application deadline for Levelland Level 2 Exchange establishment grants is November 15,2012. I encourage you to take advantage of these additional resources.
As the date approaches for submission of your Blueprint for Approval of State-based and State Partnership Exchanges, we have heard from many states that additional time would allow you to submit a more comprehensive, complete Blueprint application for your Exchange.
The deadline for a Declaration Letter for a State-based Exchange remains Friday, November 16, 2012. However, today, in order to continue to provide you with appropriate technical support if you are pursuing a State-based Exchange, HHS is extending the deadline for State-based Exchange Blueprint application submissions to Friday, December 14,2012. HHS will approve or conditionally approve the State-based Exchanges for 2014 by the statutory deadline of January 1,2013.
Additionally, if you are pursuing a State Partnership Exchange, we will accept Declaration Letters and Blueprint Applications and make approval determinations for State Partnership Exchanges on a rolling basis. The final deadline for both the Declaration Letter and Blueprint Application for State Partnership Exchanges that would be effective for 2014 has been extended to Friday, February 15,2013. And states will be able to apply to run Exchanges in subsequent years.
We are committed to providing you with the flexibility, resources, and technical assistance necessary to help you achieve successful implementation of your state's Exchange and look forward to continuing to work with you as we implement the health care law.
New York's bloated, inefficient system gets an overhaul. While that is great, it is sad that it had to get to this level before we could address it. The Feds are finally allowing states to implement it in ways that result in savings, and care improvements.
GOP Governor Begs Her Party To Expand Medicaid: ‘The Human Cost Of This Tragedy Can’t Be Calculated’
She and other right wingers thought this was "socialism" but, as always, now go hat in hand begging for a handout.Brooklyn Is God's Country!