Medicaid Wars (warning: boring)

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?"

Subject: Re: Medicaid Wars

Mougar wrote: [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!

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.

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?

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?

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.

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?)

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.

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.

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



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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.

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."

Boygabriel wrote: 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.