Okay, here’s what we do know about the current state of solvency of Medicaid post-stimulus funding: states are grappling with a larger share of Medicaid liabilities than before, and they are immediately reacting with a combination of cuts to providers/hospitals and pulling in the reins on certain services.
Although states are bearing a bigger share of the Medicaid burden this year than they have in the recent past, overall Medicaid spending (state and federal dollars) is projected to grow by only 2.2 percent, the lowest amount since 2006, [a] Kaiser report [shows]. That is because the stimulus funding ended, and program costs are stabilizing as the national economy shows tentative signs of recovery and enrollment growth slows.
The article is a lengthy one, but worth a read. The Kaiser-funded survey trial of states with respect to this question suggests many states are implementing myriad Medicaid spending stopgaps in the short term. All this is on the table as the bipartisan so-called congressional supercommittee gets ready to release its report on trimming the current budgetary deficit.
The news Wednesday morning of a 3.6 percent increase in Social Security COLA payments for 2012 is somewhat of a mixed blessing for Medicare beneficiaries, many of whom have had to shoulder stagnant SS income over the last couple of years due to negligible inflation. The increase — set to take place in January — could be offset by higher Medicare B premiums, which are deducted from SS payments.
Typically, and unsurprisingly, Medicare B premiums increase at rates higher than inflation — but those increases cannot exceed COLA, by law. Dually eligible recipients over the last couple of years, as well as higher income senior beneficiaries, were not protected from rate increases over 2010 because of Medicaid payments incurred by the former and Part B surcharges paid by the latter group.
The majority of Medicare beneficiaries, however, paint a variable picture with respect to SS income and Part B liability; and the degree of variability has to due with the amount of the monthly SS benefit paid to seniors. All of this is a stark reminder of the degree of the increasing costs of healthcare delivery on Medicare and how it compares and impacts SS entitlements year-in and year-out.
The reining in of costs associated with spiraling Medicare coverage amidst the proposed so-called “doc-fixes” addressing incessant threats of congressionally mandated cuts has many on the Hill wondering what will the Super Committee do to remedy the situation? FYI, the Super Committee is the bipartisan congressional panel made up of 6 Dems and 6 GOPers tasked with putting the brakes on deficit spending to the tune of $1.5T over the next ten years. Issues of Medicaid and Medicare spending are high on the panel’s agenda.
Specifically, futher tightening of Medicare eligibility rules and block-grant funding of Medicaid are mong the most rancorous of discussions — so much so, that at least one Republican moderate senator has chosen to distance herself from the Super Committee recommendations forthcoming. Sen Olympia Snowe (R-ME) also cites her support of branded pharma rebates (something her GOP colleagues really aren’t enthusiastic about) as another mechanism to trim costs.
The ramped-up schedule endorsed by the panel has states, insurance companies, and policywatchers of reform on the edge of their collective seats as issues of funding of the Medicare hospice benefit funding and possible elimination of the SGR formula for determining Medicare reimbursements to phsyicians and hospitals are discussed along with Medicaid funding. | LINK
While California struggles to make some headway in reconciling its budgetary woes amidst an outcry from patients, hospitals, and physicians with respect to Medicaid funding, the funding of Medicare — specifically via auterity measures to ensure its short term viability within reform — is a top concern among the same factions. Only this time, the ire is directed towards the commission charged with implementing payment scales.
The [sustainable growth rate] calls for annual, automatic cuts in Medicare payments to doctors, which Congress always delays, allowing the cuts to accumulate. MedPAC is considering a 10-year replacement that would be offset by cuts to most medical specialties. But the American Hospital Association said health care providers shouldn’t have to foot the bill for a new formula.
MedPAC knows that this is an issue which legislators are echoing, as well. It is becoming a rather common — and exasperating — rite of passage: automatic SGR cuts in Medicare reimbursements which are usually stalled by Congress; the inevitable revisiting of definitive methods to decrease healthcare costs due to Medicare next on the agenda. Most parties agree on that point, just as long as that agenda does not include massive industry cuts (read: providers) within healthcare delivery. | LINK
The requirement that new insurance provisions and services under reform and HHS rules provide the gamut of preventive womens’ healthcare services will also cover the infamous morning-after pill. Other required free services under the new rules include all birth control methods approved in the U.S., domestic violence screening, and support for breastfeeding.
The HHS noted that not every health insurance plan must comply with the new directive, however. “The administration also released an amendment to the prevention regulation that allows religious institutions that offer insurance to their employees the choice of whether or not to cover contraception services,” the agency said.
Perhaps most significantly, the rules prohibit charging a co-payment, co-insurance or deductible for this type of healthcare delivery — raising questions as to the feasibility for the feds to include such a provision in the short term. Medicare will also foot the bill for both dual-eligibles and dedicated beneficiaries. | LINK
How does obtaining health coverage (insurance) compare to not getting it at all? According to a trial published via the National Bureau of Economic Research (Harvard/MIT), beneficiaries’ quality of life was enhanced and made a “big difference” in those patients’ self-health perceptions and their daily outlook — according to the study’s lead author. A quick glance at the results confirms that all encompassing statement, especially since the study employed the diagnostic “gold standard” in trial research by utilizing a randomized, controlled design.
Taking a look at approximately the first year of coverage for Medicaid beneficiaries in the state of Orgeon, the study showed that healthcare expenditures for those who got coverage increased by almost $800/year. Those who received Medicaid were around 60 percent more likely to get mammograms. Medicaid recipients were over 50 percent more likely to have a regular primary-care doctor. They were also in better shape financially and less likely to have unpaid medical bills. Those who got Medicaid were also far more likely to report themselves in good or excellent health. ED admissions did not decrease; however, the increase in ED utilization by beneficiaries was not statistically significant.
It is clear from the results that coverage, in and of itself, has a positive effect on patients’ perceptions of health and wellness. What is not documented as much at this time is how this translates into outcomes with respect to various chronic problems such as obesity, diabetes, and risk factors (such as serum cholesterol, blood pressure, etc.) for heart disease. Also, it is unclear how these results translate into real numbers once reform increases Medicaid rolls substantially by 2014. Researchers plan on following the participants for at least another year. | LINK
There seems to be a neverending chorus on how Medicaid, as a payment system, fails on so many levels. Administrative hassles for short term gain multiplied many times during the average workweek for primary care physicians mired in all of the paperwork, all with no end in sight — unless the provider wishes to end the relationship, of course. Some states have made working with Medicaid beneficiaries more problematic, by lowering matching funding of the program on many levels. It seems like practically every state in the nation, except here in Minnesota, has taken a route in cutting their respective HHS budgets as a primary strategy to meet budgetary shortfalls head-on en route to a balanced result.
To curb rising Medicaid costs, about a dozen states are starting a new budget year by reducing payments to doctors, hospitals and other health care providers that treat the poor. Some health care experts say the cuts, most of which went into effect July 1 or will later this month, could add to a shortage of physicians and other providers participating in Medicaid.
With government projections of huge increases in Medicaid rolls by mid decade on the cusp of reform, insurers, policymakers, lawmakers, and healthcare systems are faced with the reality that numbers of beneficiaries will continue to add to the cost of care delivery in spite of reform. With the federal government planning to supplement spending to offset some of those costs, sky’s the limit on the share the feds will pay — increasing GOP fears of even more spending. With states’ assistance from stimulus (approx $100B) funds practically gone, it’s no surprise that of the 49 states with a budget, around half of those have met the deadline with Medicaid cuts to providers. HHS budgetary issues are on the table in Minnesota today as part of our state’s effort to balance the budget and end its government shutdown.
For the first time, a major private coporation is partnering with a local hospital in assisting Medicaid beneficiaries in obtaining legal assistance in squabbles with the entitlement over public health care delivery, housing, medical equipment, and other basic needs guaranteed by Medicaid. It’s not just any partnership. The corporate entity is Wal-Mart, and it insists it will not be an adversarial force to the feds. The retailer’s involvement with a local Arkansas hospital is being piloted and could become a model for future national rollout. These medical-legal partnerships, as they are called, are designed to promote changes in the healthcare public-private policy sphere by becoming part of the beneficiaries’ heatlhcare team — alongside providers and hospitals.
Onsite, legal professionals become a part of the healthcare team. Doctors will refer patients to lawyers for legal assistance when appropriate. Just as a pediatrician refers a patient to a radiologist for a broken bone, a healthcare provider may refer a patient to an onsite attorney when an underlying social circumstance impairing a patient’s health is detected.
Lest one believes that this is some conservative vs. progressive battle implemented by activists to inflame further the current drive toward reform in this administration — think again. These MLPs have the backing of the traditionally liberal-leaning American Bar Association. It is the hope of the parties involved that providing this type of legal assistance to Medicaid beneficiaries will usher in a new area of accountability by building broad public-private networks with a common goal enriching Medicaid care delivery as reform begins to take shape. | LINK
She is an extremely popular, if not equally reviled, U.S. congresswoman from Minnesota’s sixth district. Everywhere she goes, controversy, drama, and gaffes usually follow en masse. Michele Bachmann is currently relishing her role in the media spotlight, though, not all seems to be going smoothly for her. Fresh from her recent likening of herself to a serial killer, the latest public snag has less to do with poorly constructed similes and metaphors, and more to do with breaches on campaign values.
It’s no secret that Michele Bachmann condemns massive government funding for healthcare delivery, allowing her to utter dispassionately the phrase “Obamacare” at virtually every campaign stop. Her attacks on Medicare, Medicaid, and health reform in general are well known and have certainly have created for her a coveted niche at the top of the 2012 GOP heap along with top billing by the presumptive front runner Mitt Romney. But, until now, it’s the little known benefit that her husband, a licensed psychologist, apparently received at the hand of the federal government that will eclipse her more previously innocuous missteps.
The mental health clinic run by her husband has been collecting annual Medicaid payments totaling over $137,000 for the treatment of patients since 2005. Initially, Bachmann said the fed-state reimbursements were a one-time event — funds used for training staff and initial services. More importantly, however, is the fact that, in spite of her proclamations of Medicare and Medicaid enrollments increasing the “welfare rolls”, her husband’s practice was a direct beneficiary. I guess we’ll see what gaffes develop from this latest issue. | LINK
Originating from Saint Paul, Minnesota, [doctorpundit.com] is a weblog about the policy of healthcare and where it intersects with politics and public opinion; it is edited by Michael Douglas, MD, MBA. Welcome, and please consider my take on what is Healthcare 2.0, complemented by a few of my thoughts on my personal avocations and guilty pleasures: music, prose, and writing. Follow Doctor Pundit via RSS above.
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DOCTOR PUNDIT @ ONE YEAR | An occasional DP series from 2010 highlighting healthcare policy trends over the period from 2009-2010 in a compare/contrast format.
