Political Fight Jeopardizes Medicaid In Mississippi
Medicaid and controversy seem inseparable in many states lately. For the most part, the wrangling is about a new wrinkle in Medicaid — the expansion of the health program for the poor and disabled under Obamacare.
Mississippi, though, is raising the stakes. Democrats and Republicans in the state are in a fight, and the outcome could threaten the very existence of the entire Medicaid program there.
More than 700,000 Mississippians get Medicaid, with the federal government paying about three-quarters of the cost and the state picking up the rest of the tab. The federal Affordable Care Act calls for expanding Medicaid to roughly 300,000 additional low-income Mississippians. Initially, the federal government would pay the entire bill, and after a few years, the state would finance 10 percent.
When the U.S. Supreme Court made the expansion of Medicaid optional for states last year, Republicans in Mississippi, led by Gov. Phil Bryant, adamantly refused to go along.
"I do not believe that the federal government has the revenue to fully fund Medicaid across the United States of America," said Bryant, "I am not going to fall into this trap and leave the taxpayers of Mississippi holding the bill."
Democrats pushed back and made Medicaid expansion a legislative priority.
Gov. Bryant Guest Editorial: Expanding Medicaid will cost Mississippians
There has been much public discussion lately about the so-called Affordable Care Act, also known as “Obamacare.” In Mississippi, as in many other states, a particular subject of debate is whether or not to expand the Medicaid program, our state’s largest and most costly entitlement program. In our own Legislature, the issue has become so heated that many Democrat lawmakers are choosing to suspend the current Medicaid program that cares for the blind, aged and disabled in order to force a decision on Obamacare expansion. Cooler heads must prevail.
Obamacare is packed full of mandates and regulations that will pose huge costs to our state. In fact, the 2014 onset of Obamacare — without a Medicaid expansion — will add $32 million to Mississippi’s existing Medicaid expenditures. For perspective, $32 million is more than four times the State general fund budget for our fighting men and women in the Mississippi National Guard. Even more troubling, while $32 million is a very large sum of money, it is dwarfed by our current Medicaid budget. This year, Mississippi will spend between $800 and $900 million on Medicaid — about 18 times what we spend for the Highway Patrol and more than 38 times what we spend on economic development and job creation.
Yet, Democrat lawmakers and lobbyists are clamoring to immediately expand the Medicaid program — potentially adding an additional $1 billion to our already enormous Medicaid budget. They want to force this new burden on you, the taxpayers, before we even have all of the necessary information about the costs and ramifications from the federal government. Hospitals and other special-interest groups are pushing talking points designed to create panic when, in reality, states are waiting on the federal government for information about how Medicaid payments to hospitals will be made in the future. At this point in time, we simply don’t have all of the facts — all the more reason not to rush headlong into a very serious decision.http://www.governorbryant.com/gov-bryant-guest-editorial-expanding-medicaid-will-cost-mississippians/
A Louisville Clinic Races to Adapt to the Health Care Overhaul
By ABBY GOODNOUGH
LOUISVILLE, Ky. — One morning last month, a health clinic next to a scruffy strip mall here had an unlikely visitor: a man in a suit and tie, seeking to bring a dose of M.B.A. order to the operation.
A dozen clinic employees, who spend intense, chaotic days treating an unending stream of Louisville’s poor and uninsured, stared stonily at handouts he had brought as he made his pitch.
The visitor was Danny DuBosque, a “coach” hired to help the nonprofit clinic adapt to the demands of the federal health care overhaul. He had come to discuss a new appointment system, one that will let patients see a doctor or nurse within a few days of calling, instead of weeks or months.
“It’s a huge satisfier,” he declared — management-speak that fell flat with Dr. Michelle Elisburg, a pediatrician who was scheduled to see 26 patients that day.
“It puts me on edge,” said Dr. Elisburg, who has spent her career treating the poor. “Under this model, it’s first come first served, whoever calls fastest. But that’s not necessarily the patient who really needs to be seen.”
Mr. DuBosque, 35, raised his arms, a plea for patience. “We’re going to take the next few years going through and untangling all these issues,” he said before hurrying to another meeting.
“It’s frightening,” Dr. Elisburg, 42, murmured as Mr. DuBosque left.
The debate that morning was just one expression of the tensions rippling through medical offices around the country in the countdown to January, when the Affordable Care Act will require most Americans to have health insurance or pay a tax penalty. For doctors and their staffs, this is a period of fevered preparation for the far-reaching changes that are soon to come as the law moves out of the realm of political jousting and into the real world.
To follow how the historic law is playing out, The New York Times will look periodically at its impact in Louisville, a city of 600,000 that embodies both the triumphs and the shortcomings of the medical system in the United States.
The nation’s first hand transplant was performed here, as was the world’s first implant of a self-contained artificial heart. One of the nation’s largest insurers, Humana, is based here, and the city’s downtown area alone has four hospitals and a medical school. Health care increasingly fuels the local economy, accounting for many of the largest employers and a growing number of start-ups.
Yet for all the resources and expertise, the health outcomes in Kentucky remain “horrendous,” as Gov. Steven L. Beshear, a Democrat, put it recently. The state has some of the nation’s highest rates of smoking, obesity and deaths due to cancer and diabetes. At this point, the only sure thing about putting the law’s many pieces in place here is that it will not be easy.
Why a Health Insurance Penalty May Look Tempting
By ANNA BERNASEK
OFTEN, when the government wants you to do something, it makes you pay if you don’t. That would seem to be the case with Obamacare, which penalizes companies for not providing health care. But in that penalty, there could be a paradoxical result: dropping health coverage could save companies a lot of money.
Once new health insurance exchanges are up and running in October, companies with 50 or more full-time employees will face a choice: Provide affordable care to all full-time employees, or pay a penalty. But that penalty is only $2,000 a person, excluding the first 30 employees. With an employer’s contribution to family health coverage now averaging $11,429 a year, taking that penalty would seem to yield big savings.
Yet there may be costs in employee satisfaction, especially if companies don’t raise pay enough to keep workers whole when they buy insurance on the exchanges.
“No one wants to drop health insurance and have unhappy employees,” says Rick Wald, who heads Deloitte’s employer health care consulting practice.
Few experts see immediate, big changes to existing employer-sponsored coverage. But that may change in time. A generation ago, defined-benefit pensions were prevalent. Not so today.
So why did the government set the penalty at $2,000?
Policy experts don’t agree on the rationale, and the White House didn’t respond to requests for comment. Perhaps the intent was to start a gradual shift from employer-sponsored coverage to the new exchanges. Or maybe the low amount was a compromise needed to pass the law.
Whatever the reason, the government is about to conduct a huge experiment in corporate decision-making.
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