Friday, August 19, 2005
Aetna responds to consumer-driven market pressure
[Vanessa Fuhrmans, "Insurer Reveals What Doctors Really Charge," The Wall Street Journal, 18 August 2005.]
Lack of information is often held up as a reason why consumers cannot act rationally in the health care marketplace. As The Wall Street Journal reports, however, insurers are moving to address this issue:
Starting tomorrow, Aetna Inc. plans to make available online the exact prices it has negotiated with Cincinnati-area doctors for hundreds of medical procedures and tests. The initiative, which Aetna hopes to take eventually to other parts of the country, aims to give patients the tools to comparison shop and make savvier decisions with their health-care dollars.
Aetna is the first major health insurer to publicly disclose the fees it negotiates with physicians. Some in the health-care industry say the move is likely to push more insurers to follow suit, which in turn would give a significant boost to consumer-driven health plans.
"To create a more functional health-care market, we needed more transparency," says Ron Williams, Aetna's president.
As fee information becomes more readily available, it is likely to put more pressure on doctors to compete on price, says Regina Herzlinger, professor of business administration at the Harvard Business School and a leading consumer-directed health-care advocate. That, in turn, may prod physicians to publish or share data on the quality of the care they provide, she says, even though some have resisted attempts at doctor quality ratings until now. "If I were a doctor, I would want to demonstrate all the things I offer besides price," says Prof. Herzlinger.
Competition may be one reason Aetna is moving aggressively. As consumer-driven plans rise in popularity, health insurers will compete less on premiums and more on the financial and information services consumers will need to use them effectively.
[Devon Herrick, "Health Insurance Is Better To Own Than Rent," The Dodge City Globe, 23 March 2005.
John McClaughry, "Patient Power: A Health Care Reform Agenda for Kansas," The Flint Hills Center, May 2004.]
[Vanessa Fuhrmans, "Insurer Reveals What Doctors Really Charge," The Wall Street Journal, 18 August 2005.]
Lack of information is often held up as a reason why consumers cannot act rationally in the health care marketplace. As The Wall Street Journal reports, however, insurers are moving to address this issue:
Starting tomorrow, Aetna Inc. plans to make available online the exact prices it has negotiated with Cincinnati-area doctors for hundreds of medical procedures and tests. The initiative, which Aetna hopes to take eventually to other parts of the country, aims to give patients the tools to comparison shop and make savvier decisions with their health-care dollars.
Aetna is the first major health insurer to publicly disclose the fees it negotiates with physicians. Some in the health-care industry say the move is likely to push more insurers to follow suit, which in turn would give a significant boost to consumer-driven health plans.
"To create a more functional health-care market, we needed more transparency," says Ron Williams, Aetna's president.
As fee information becomes more readily available, it is likely to put more pressure on doctors to compete on price, says Regina Herzlinger, professor of business administration at the Harvard Business School and a leading consumer-directed health-care advocate. That, in turn, may prod physicians to publish or share data on the quality of the care they provide, she says, even though some have resisted attempts at doctor quality ratings until now. "If I were a doctor, I would want to demonstrate all the things I offer besides price," says Prof. Herzlinger.
Competition may be one reason Aetna is moving aggressively. As consumer-driven plans rise in popularity, health insurers will compete less on premiums and more on the financial and information services consumers will need to use them effectively.
[Devon Herrick, "Health Insurance Is Better To Own Than Rent," The Dodge City Globe, 23 March 2005.
John McClaughry, "Patient Power: A Health Care Reform Agenda for Kansas," The Flint Hills Center, May 2004.]
Colorado empowers Medicaid recipients
[John Andrews, "Rocky Mountain Medicaid," The Wall Street Journal, 18 August 2005.]
Policymakers that are willing to allow Medicaid beneficiaries more control over their care are increasingly finding that satisfaction increases and costs decline. Considering that cost and quality of care are the two perennial problems with Medicaid, this is a huge development:
CDAS, our state's experiment with Consumer-Directed Attendant Support for the severely disabled, got started in 2002. The wheelchair-bound Linda Storey was one of its first four clients. The program now has 146 participants, each newly empowered to hire and fire their own caregivers. Quality of care and patient satisfaction are up, costs are down, and legislators approved offering the option for 33,000 Medicaid recipients statewide in 2006.
"It gives you your life back," [Linda] Storey told me. "I'm in control of my health now." Under a federal waiver obtained by Colorado officials, she selects the health aides who come to her house, bypassing the provider agencies otherwise required under Medicaid rules for home- and community-based services.
Jessica, a 21-year-old anthropology student, now gets to be one of those paid caregivers. Nowadays, the entire team of aides is reliable and well qualified, she told me -- in contrast to the ill-trained and even scary individuals sent in by agencies over the years. Several even robbed the family, Jessica recalled.
"Since I have been on CDAS . . . I have more freedom to live my life as every American should -- and I'm saving the government money," [says Storey.]
With Medicaid expenses surging faster than almost every other budget line in almost every state, such savings are welcome news to policy makers. Taxpayers in Colorado have seen their share of Medicaid -- matched dollar for dollar with federal funds -- increase almost 33% since 2001. Another 22% jump is predicted by 2010.
The first two years of Colorado's CDAS pilot program, by contrast, showed average monthly spending at 21% under budget ($3,925 per client allocated, $3,131 expended). While the sample is tiny, the vector is positive for once.
The goal is clear, according to Matt Dunn, a young dentist named by Gov. Owens to the Medicaid oversight board. First give patients freedom to choose. Then align incentives so the choices go less and less toward a demeaning, inefficient government delivery model. "Socialized medicine benefits no one," Mr. Dunn insists with Colorado candor. To which Linda Storey would say alleluia, amen.
[Devon M. Herrick, "Give Medicaid recipients more control," The Wichita Eagle, 3 March 2005.]
[John Andrews, "Rocky Mountain Medicaid," The Wall Street Journal, 18 August 2005.]
Policymakers that are willing to allow Medicaid beneficiaries more control over their care are increasingly finding that satisfaction increases and costs decline. Considering that cost and quality of care are the two perennial problems with Medicaid, this is a huge development:
CDAS, our state's experiment with Consumer-Directed Attendant Support for the severely disabled, got started in 2002. The wheelchair-bound Linda Storey was one of its first four clients. The program now has 146 participants, each newly empowered to hire and fire their own caregivers. Quality of care and patient satisfaction are up, costs are down, and legislators approved offering the option for 33,000 Medicaid recipients statewide in 2006.
"It gives you your life back," [Linda] Storey told me. "I'm in control of my health now." Under a federal waiver obtained by Colorado officials, she selects the health aides who come to her house, bypassing the provider agencies otherwise required under Medicaid rules for home- and community-based services.
Jessica, a 21-year-old anthropology student, now gets to be one of those paid caregivers. Nowadays, the entire team of aides is reliable and well qualified, she told me -- in contrast to the ill-trained and even scary individuals sent in by agencies over the years. Several even robbed the family, Jessica recalled.
"Since I have been on CDAS . . . I have more freedom to live my life as every American should -- and I'm saving the government money," [says Storey.]
With Medicaid expenses surging faster than almost every other budget line in almost every state, such savings are welcome news to policy makers. Taxpayers in Colorado have seen their share of Medicaid -- matched dollar for dollar with federal funds -- increase almost 33% since 2001. Another 22% jump is predicted by 2010.
The first two years of Colorado's CDAS pilot program, by contrast, showed average monthly spending at 21% under budget ($3,925 per client allocated, $3,131 expended). While the sample is tiny, the vector is positive for once.
The goal is clear, according to Matt Dunn, a young dentist named by Gov. Owens to the Medicaid oversight board. First give patients freedom to choose. Then align incentives so the choices go less and less toward a demeaning, inefficient government delivery model. "Socialized medicine benefits no one," Mr. Dunn insists with Colorado candor. To which Linda Storey would say alleluia, amen.
[Devon M. Herrick, "Give Medicaid recipients more control," The Wichita Eagle, 3 March 2005.]
Thursday, August 18, 2005
Galen Institute: 6 million HSA holders by 2008
[Grace-Marie Turner, "Consumerism in Health Care: Early Evidence is Positive," The Galen Institute, 11 August 2005.]
Grace-Marie Turner unleashes a torrent of data revealing the overwhelming success of consumer-driven health care in this recent report:
As more Americans move into consumer-directed health plans, more and more studies are being produced that report on early experience with these plans.
We have released a paper that summarizes some of the newest studies of these products, including Health Savings Accounts and Health Reimbursement Arrangements, which offer new incentives for consumers to help manage their health care and health costs.
The bottom line: Consumerism is working in these plans, with costs moderating while maintaining access to needed care, including preventive and chronic care treatments.
[Greg Scandlen, "Choice is revolutionizing health care," The Wichita Eagle, 28 September 2004.]
[Grace-Marie Turner, "Consumerism in Health Care: Early Evidence is Positive," The Galen Institute, 11 August 2005.]
Grace-Marie Turner unleashes a torrent of data revealing the overwhelming success of consumer-driven health care in this recent report:
As more Americans move into consumer-directed health plans, more and more studies are being produced that report on early experience with these plans.
We have released a paper that summarizes some of the newest studies of these products, including Health Savings Accounts and Health Reimbursement Arrangements, which offer new incentives for consumers to help manage their health care and health costs.
The bottom line: Consumerism is working in these plans, with costs moderating while maintaining access to needed care, including preventive and chronic care treatments.
[Greg Scandlen, "Choice is revolutionizing health care," The Wichita Eagle, 28 September 2004.]
More absurdity in The Cap-Journal
[Greg Tarpinian, "Universal health care -- auto industry's last hope," MinutemanMedia.org, The Topeka Capital-Journal, 12 Friday 2005.]
It used to be that The Topeka Capital-Journal was willing to consider opinion pieces from any and all. In those days, even The Flint Hills Center was able to get a piece or two printed.
At some point, however, an executive decision was made to eliminate local content from its opinion section. The Cap-Journal still sends out plenty of opinions these days - they are just posted online instead of in print. Local content there, however, is still a rare sighting.
Instead, readers are flooded with columns from the far-left organization MinuteManMedia. I have no way to guage if readers appreciate this, but my guess is most everyone would like a change of pace now and then.
In any case, here's a union-backed piece from MinuteMan that just ran which advocates socialized medicine as the answer to the auto industry's many problems:
The financial crisis born of mismanagement leaves the companies facing costs they cannot cover, including health care costs.
GM paid out $5.2 billion for health care benefits in 2004 and expects to pay out $5.8 billion this year. These benefit costs are part of the total compensation negotiated in union contracts that traded what would have been higher wage increases for better benefit provisions.
The costs have been exacerbated by the unwillingness of the Bush administration and Congress to address the catastrophic rise of health care costs in the United States. GM's $73 billion liability for retiree health benefits could be covered three times over by the amount the United States squanders every year on administrative costs for its private health care system.
China and India will begin exporting cars to the United States within the next few years. Carmakers in both countries benefit from national health care systems that pay for employee benefits with public funds.
The U.S. automakers are moving more production to Canada where a national health care program provides coverage for workers and their families for less than one-fifth of the cost of health benefits on the U.S. side of the border.
The Bush administration has a choice. It can preside over the dissolution of what remains of the U.S. auto industry or it can take the first steps toward a national solution for the health care cost crisis that is distorting labor markets, driving down disposable income, leaving millions of Americans without health care and creating the largest competitive disadvantage that U.S. companies now face.
Well, he had me with the first half of the article where he detailed GM's financial mismanagement and poor planning. I get lost when he then makes the leap to say that these bad business decisions should be rewarded with a federal bail out. Plenty of other industries are struggling with health care costs and not asking to turn the system of private medicine into a government monopoly.
The fact that China and India and Canada have nationalized health care hardly makes the case that we should follow suit here. Even with its flaws, the American health care system is far superior to any of these. If other countries choose to subsidize their health care they will accomplish two things - a diversion of resources away from better uses, and a reduction in the quality and availability of health care generally. In other words, less for more.
It might be easier simply to seal off the borders to any international trade so our domestic firms need not worry about competition from countries with nationalized health coverage. That, however, would be an equally absurd example of where what's good for GM is far from what's best for everyone else in the country.
["Matt Hisrich responds to Kansas Insurance Commissioner calls for nationalized health care," The Flint Hills Center, 22 July 2004.]
[Greg Tarpinian, "Universal health care -- auto industry's last hope," MinutemanMedia.org, The Topeka Capital-Journal, 12 Friday 2005.]
It used to be that The Topeka Capital-Journal was willing to consider opinion pieces from any and all. In those days, even The Flint Hills Center was able to get a piece or two printed.
At some point, however, an executive decision was made to eliminate local content from its opinion section. The Cap-Journal still sends out plenty of opinions these days - they are just posted online instead of in print. Local content there, however, is still a rare sighting.
Instead, readers are flooded with columns from the far-left organization MinuteManMedia. I have no way to guage if readers appreciate this, but my guess is most everyone would like a change of pace now and then.
In any case, here's a union-backed piece from MinuteMan that just ran which advocates socialized medicine as the answer to the auto industry's many problems:
The financial crisis born of mismanagement leaves the companies facing costs they cannot cover, including health care costs.
GM paid out $5.2 billion for health care benefits in 2004 and expects to pay out $5.8 billion this year. These benefit costs are part of the total compensation negotiated in union contracts that traded what would have been higher wage increases for better benefit provisions.
The costs have been exacerbated by the unwillingness of the Bush administration and Congress to address the catastrophic rise of health care costs in the United States. GM's $73 billion liability for retiree health benefits could be covered three times over by the amount the United States squanders every year on administrative costs for its private health care system.
China and India will begin exporting cars to the United States within the next few years. Carmakers in both countries benefit from national health care systems that pay for employee benefits with public funds.
The U.S. automakers are moving more production to Canada where a national health care program provides coverage for workers and their families for less than one-fifth of the cost of health benefits on the U.S. side of the border.
The Bush administration has a choice. It can preside over the dissolution of what remains of the U.S. auto industry or it can take the first steps toward a national solution for the health care cost crisis that is distorting labor markets, driving down disposable income, leaving millions of Americans without health care and creating the largest competitive disadvantage that U.S. companies now face.
Well, he had me with the first half of the article where he detailed GM's financial mismanagement and poor planning. I get lost when he then makes the leap to say that these bad business decisions should be rewarded with a federal bail out. Plenty of other industries are struggling with health care costs and not asking to turn the system of private medicine into a government monopoly.
The fact that China and India and Canada have nationalized health care hardly makes the case that we should follow suit here. Even with its flaws, the American health care system is far superior to any of these. If other countries choose to subsidize their health care they will accomplish two things - a diversion of resources away from better uses, and a reduction in the quality and availability of health care generally. In other words, less for more.
It might be easier simply to seal off the borders to any international trade so our domestic firms need not worry about competition from countries with nationalized health coverage. That, however, would be an equally absurd example of where what's good for GM is far from what's best for everyone else in the country.
["Matt Hisrich responds to Kansas Insurance Commissioner calls for nationalized health care," The Flint Hills Center, 22 July 2004.]
Wednesday, August 17, 2005
S.C. earns more attention
[Kevin Freking, "S.C. proposing to redefine Medicaid," Associated Press, The Wichita Eagle, 16 August 2005.]
South Carolina's plan to salvage its broken Medicaid program is getting national attention as state leaders around the country attempt to come up with answers to this budget and health care headache. Michael Bond, who has written for and appeared on behalf of The Flint Hills Center, has been actively involved in the plan's development from the beginning:
The state says its proposal to establish personal health accounts for most of the state's 850,000 Medicaid recipients will "redefine health care in the United States."
The account would be used to purchase private health insurance, or pay for care directly. And the amount of money allocated to each account would depend on the person's age, sex and physical condition.
That's much different from the way Medicaid operates. Now, those whose incomes are low enough and who meet other eligibility requirements are entitled to receive certain approved health care services regardless of costs.
South Carolina would cap how much it will spend on a recipient, and if health care costs more than the account will pay for, then the low-income people would have to make up the difference themselves or go without.
States have to get waivers from the federal government whenever they want to use federal Medicaid funds in ways not authorized in federal law. But the implications of South Carolina's waiver request, contained in a 42-page document submitted to the Centers for Medicare and Medicaid Services in June, extend far beyond South Carolina.
If South Carolina's plan is approved, analysts say, other states will seek similar changes. Eventually, the experiment could influence national policy, said Nina Owcharenko, a senior health care analyst with the Heritage Foundation, a conservative think tank.
"Remember, welfare reform didn't come from Washington the first time around," she said. "It came from states like Wisconsin, which received waivers, and their work later encouraged new federal policy."
Devon Herrick, a senior fellow at the National Center for Policy Analysis, said the plan promotes personal responsibility.
"If they've made wise choices, they might have money left over," Mr. Herrick said. "If they've made poor choices, it might take some money out of their pockets."
[Michael Bond and Matthew Hisrich, "Medicaid Lessons from Former Communists," WIBA Newsletter, February 2005.
Devon M. Herrick, "Give Medicaid recipients more control," The Wichita Eagle, 3 March 2005.]
[Kevin Freking, "S.C. proposing to redefine Medicaid," Associated Press, The Wichita Eagle, 16 August 2005.]
South Carolina's plan to salvage its broken Medicaid program is getting national attention as state leaders around the country attempt to come up with answers to this budget and health care headache. Michael Bond, who has written for and appeared on behalf of The Flint Hills Center, has been actively involved in the plan's development from the beginning:
The state says its proposal to establish personal health accounts for most of the state's 850,000 Medicaid recipients will "redefine health care in the United States."
The account would be used to purchase private health insurance, or pay for care directly. And the amount of money allocated to each account would depend on the person's age, sex and physical condition.
That's much different from the way Medicaid operates. Now, those whose incomes are low enough and who meet other eligibility requirements are entitled to receive certain approved health care services regardless of costs.
South Carolina would cap how much it will spend on a recipient, and if health care costs more than the account will pay for, then the low-income people would have to make up the difference themselves or go without.
States have to get waivers from the federal government whenever they want to use federal Medicaid funds in ways not authorized in federal law. But the implications of South Carolina's waiver request, contained in a 42-page document submitted to the Centers for Medicare and Medicaid Services in June, extend far beyond South Carolina.
If South Carolina's plan is approved, analysts say, other states will seek similar changes. Eventually, the experiment could influence national policy, said Nina Owcharenko, a senior health care analyst with the Heritage Foundation, a conservative think tank.
"Remember, welfare reform didn't come from Washington the first time around," she said. "It came from states like Wisconsin, which received waivers, and their work later encouraged new federal policy."
Devon Herrick, a senior fellow at the National Center for Policy Analysis, said the plan promotes personal responsibility.
"If they've made wise choices, they might have money left over," Mr. Herrick said. "If they've made poor choices, it might take some money out of their pockets."
[Michael Bond and Matthew Hisrich, "Medicaid Lessons from Former Communists," WIBA Newsletter, February 2005.
Devon M. Herrick, "Give Medicaid recipients more control," The Wichita Eagle, 3 March 2005.]
Tuesday, August 16, 2005
Moses to debate long-term care at Cato event
Steve Moses of The Center for Long Term Care Financing will be appearing at a Cato Institute event that will be broadcast online:
Medicaid and the Long-Term Care Crisis -- Who Should Pay?
POLICY FORUM
Wednesday, September 7, 2005
12:00 PM (Luncheon to follow)
Featuring Stephen A. Moses, President, Center for Long-Term Care Reform, Inc.; Vincent J. Russo, Certified Elder Law Attorney, Past President, National Academy of Elder Law Attorneys; with comments by Michael F. Cannon, Director of Health Policy Studies, Cato Institute; and moderated by Ceci Connolly,* National Health Policy Reporter, Washington Post.
Medicaid, the joint federal-state health care program created in 1965 for the poor, is imposing a growing burden on taxpayers. It has grown larger than Medicare, the federal health care program for the elderly, and already accounts for a larger share of state expenditures than elementary and secondary education. Part of that growth is due to many middle-income seniors using Medicaid to pay for nursing home expenses and other long-term care. Those seniors own assets that could cover such expenses for a period of time, either directly or by purchasing long-term care insurance. Should their assets be used to help Congress cut projected Medicaid expenditures? Please join us for a debate that could profoundly affect the future of Medicaid and long-term care.
If you can't make it to the Cato Institute, watch this forum live online.
[Stephen Moses, "Nursing home system in need of reform," The Pittsburg Morning Sun, 22 May 2005.]
Steve Moses of The Center for Long Term Care Financing will be appearing at a Cato Institute event that will be broadcast online:
Medicaid and the Long-Term Care Crisis -- Who Should Pay?
POLICY FORUM
Wednesday, September 7, 2005
12:00 PM (Luncheon to follow)
Featuring Stephen A. Moses, President, Center for Long-Term Care Reform, Inc.; Vincent J. Russo, Certified Elder Law Attorney, Past President, National Academy of Elder Law Attorneys; with comments by Michael F. Cannon, Director of Health Policy Studies, Cato Institute; and moderated by Ceci Connolly,* National Health Policy Reporter, Washington Post.
Medicaid, the joint federal-state health care program created in 1965 for the poor, is imposing a growing burden on taxpayers. It has grown larger than Medicare, the federal health care program for the elderly, and already accounts for a larger share of state expenditures than elementary and secondary education. Part of that growth is due to many middle-income seniors using Medicaid to pay for nursing home expenses and other long-term care. Those seniors own assets that could cover such expenses for a period of time, either directly or by purchasing long-term care insurance. Should their assets be used to help Congress cut projected Medicaid expenditures? Please join us for a debate that could profoundly affect the future of Medicaid and long-term care.
If you can't make it to the Cato Institute, watch this forum live online.
[Stephen Moses, "Nursing home system in need of reform," The Pittsburg Morning Sun, 22 May 2005.]
Humana opens doors to small employers
["Humana to offer health savings accounts to all commercial groups," Louisville Business First, 28 July 2005.]
Business First reports that Humana is making it easier for even the smallest employers to offer their employees health coverage:
Humana Inc. is expanding its "Smart" family of consumer-driven products to include a health-savings account option for all commercial groups with at least two employees.
Humana's "Smart" plans include SmartSuite, SmartSelect and SmartExpress. SmartSuite and SmartSelect are for groups with 300 or more members, and SmartExpress is aimed at employers with between two and 299 employees.
Humana is offering various high-deductible health plans with the HSAs. Members with single coverage can choose deductibles ranging from $1,500 to $5,000, and deductibles for those with family coverage range from $3,000 to $10,000.
Coinsurance percentages associated with these plans are 100 percent in-network coverage and 70 percent out-of-network coverage, 90-60 or 80-50, respectively.
Starting this month, Humana HSA members will be able to access their funds by using a special HumanaAccess HSA Visa debit card when paying for medical services.
Mutual funds will be available for the investment portion of HSAs. Also, Humana will provide members with electronic and telephonic access to account balances, request reimbursements and other services.
Information on individual plans in Kansas is available here, and group plan information is available here.
[Matthew Hisrich, "HSAs Are Increasing Americans' Health Coverage," The Topeka Capital-Journal, 26 September 2004.]
["Humana to offer health savings accounts to all commercial groups," Louisville Business First, 28 July 2005.]
Business First reports that Humana is making it easier for even the smallest employers to offer their employees health coverage:
Humana Inc. is expanding its "Smart" family of consumer-driven products to include a health-savings account option for all commercial groups with at least two employees.
Humana's "Smart" plans include SmartSuite, SmartSelect and SmartExpress. SmartSuite and SmartSelect are for groups with 300 or more members, and SmartExpress is aimed at employers with between two and 299 employees.
Humana is offering various high-deductible health plans with the HSAs. Members with single coverage can choose deductibles ranging from $1,500 to $5,000, and deductibles for those with family coverage range from $3,000 to $10,000.
Coinsurance percentages associated with these plans are 100 percent in-network coverage and 70 percent out-of-network coverage, 90-60 or 80-50, respectively.
Starting this month, Humana HSA members will be able to access their funds by using a special HumanaAccess HSA Visa debit card when paying for medical services.
Mutual funds will be available for the investment portion of HSAs. Also, Humana will provide members with electronic and telephonic access to account balances, request reimbursements and other services.
Information on individual plans in Kansas is available here, and group plan information is available here.
[Matthew Hisrich, "HSAs Are Increasing Americans' Health Coverage," The Topeka Capital-Journal, 26 September 2004.]
Medicaid needs a makeover
["Medicaid needs a makeover," NCPA Daily Policy Digest, 15 August 2005.]
Medicaid reform is gaining steam both at the state and federal level, and as this entry from NCPA's Daily Policy Digest shows, the latter can be a big help to the former:
The Medicaid program has deviated drastically from its original mission of covering the poorest individuals. Now some 53 million are enrolled in Medicaid, including 25 percent of all children and two-thirds of nursing home residents. Consequently, state are now looking at solutions to curb the burgeoning cost, says the National Journal.
While the federal government mandates that states cover a certain segment of the population, states enroll "optional" populations as well, resulting in increasing budget pressures. In 2001, the Bush administration responded by implementing a waiver program to allow states to cut benefits and cap enrollment for mandatory populations.
Indeed, John Goodman of the National Center for Policy Analysis argues that Medicaid is too restrictive and that federal rules "make it hard to do sensible things...like to have co-payments or set up HSAs."
Congress will soon look at ways to cut $10 billion in federal spending from the Medicaid budget. Republicans argue that if Medicaid is to survive, it must behave more like the private system.
[Matthew Hisrich, "Staying the Course: Medicaid Reform in Kansas," The Flint Hills Center for Public Policy, February 2004.]
["Medicaid needs a makeover," NCPA Daily Policy Digest, 15 August 2005.]
Medicaid reform is gaining steam both at the state and federal level, and as this entry from NCPA's Daily Policy Digest shows, the latter can be a big help to the former:
The Medicaid program has deviated drastically from its original mission of covering the poorest individuals. Now some 53 million are enrolled in Medicaid, including 25 percent of all children and two-thirds of nursing home residents. Consequently, state are now looking at solutions to curb the burgeoning cost, says the National Journal.
While the federal government mandates that states cover a certain segment of the population, states enroll "optional" populations as well, resulting in increasing budget pressures. In 2001, the Bush administration responded by implementing a waiver program to allow states to cut benefits and cap enrollment for mandatory populations.
Indeed, John Goodman of the National Center for Policy Analysis argues that Medicaid is too restrictive and that federal rules "make it hard to do sensible things...like to have co-payments or set up HSAs."
Congress will soon look at ways to cut $10 billion in federal spending from the Medicaid budget. Republicans argue that if Medicaid is to survive, it must behave more like the private system.
[Matthew Hisrich, "Staying the Course: Medicaid Reform in Kansas," The Flint Hills Center for Public Policy, February 2004.]
Monday, August 15, 2005
Welfare reform as a model for Medicaid reform
[Mary Katherine Stout, "Ending The 40-Year Entitlement," The Texas Public Policy Foundation, 29 July 2005.]
In this recent column, TPPF health care policy analyst Mary Katherine Stout points out that Medicaid is not the first goverment program that needed to scale back from being an open-ended entitlement to return to its role as a safety net for the truly needy:
In 1996, the United States Congress passed landmark welfare reform legislation, making it the most sweeping entitlement overhaul this country has ever seen. Today, nearly ten years after Congress’ bold action, the lessons of welfare reform should serve as the blueprint for reforming Medicaid, an even bigger entitlement program threatening state budgets across the country.
As Medicaid celebrates its 40th birthday, it has become a government leviathan, devouring state budgets and leaving taxpayers bracing for the future. Although eligibility was originally limited to those qualifying for welfare’s cash assistance, the Medicaid program has grown to encompass a growing number of people and services.
Now, states are desperate for Medicaid reform to control costs and rid the program of rigid federal requirements. The path for achieving these reforms is clear: end the entitlement and give states greater flexibility.
Welfare reform changed the way federal funding came to the state by giving the state a fixed amount of money to run their program, and providing bonuses to states achieving high performance. Medicaid reform should take the same approach by prioritizing spending, and establishing broad goals for performance. States must have significant authority to tailor the program to fit their needs, and wide latitude to better align Medicaid with other government assistance programs.
What’s more, Medicaid must be a program with reciprocal obligation. Medicaid recipients should share in the cost of their care by paying meaningful monthly premiums and copayments. Since 1982, copayments have been limited to a nominal amount of no more than $3, in most cases.
Although median family income today tops $43,000 and a stamp costs 37 cents, Medicaid’s copayments are effectively frozen in 1982 – when median family income was just over $20,000 and a stamp was 20 cents.
Many of Medicaid’s fiercest advocates are already objecting to suggested reforms that would control spending, taking particular exception to increased cost sharing. Such a position defies reality and reason.
Welfare reform successfully restored the idea that government assistance doesn’t come free or without obligation; a concept most Americans understand whether they are working for a paycheck or paying for a doctor visit.
Medicaid reform must tackle the entitlement and provide states the flexibility they need while giving recipients greater responsibility over their lives.
[Matthew Hisrich, "A Backgrounder on Kansas Medicaid," The Flint Hills Center, 19 July 2004.]
[Mary Katherine Stout, "Ending The 40-Year Entitlement," The Texas Public Policy Foundation, 29 July 2005.]
In this recent column, TPPF health care policy analyst Mary Katherine Stout points out that Medicaid is not the first goverment program that needed to scale back from being an open-ended entitlement to return to its role as a safety net for the truly needy:
In 1996, the United States Congress passed landmark welfare reform legislation, making it the most sweeping entitlement overhaul this country has ever seen. Today, nearly ten years after Congress’ bold action, the lessons of welfare reform should serve as the blueprint for reforming Medicaid, an even bigger entitlement program threatening state budgets across the country.
As Medicaid celebrates its 40th birthday, it has become a government leviathan, devouring state budgets and leaving taxpayers bracing for the future. Although eligibility was originally limited to those qualifying for welfare’s cash assistance, the Medicaid program has grown to encompass a growing number of people and services.
Now, states are desperate for Medicaid reform to control costs and rid the program of rigid federal requirements. The path for achieving these reforms is clear: end the entitlement and give states greater flexibility.
Welfare reform changed the way federal funding came to the state by giving the state a fixed amount of money to run their program, and providing bonuses to states achieving high performance. Medicaid reform should take the same approach by prioritizing spending, and establishing broad goals for performance. States must have significant authority to tailor the program to fit their needs, and wide latitude to better align Medicaid with other government assistance programs.
What’s more, Medicaid must be a program with reciprocal obligation. Medicaid recipients should share in the cost of their care by paying meaningful monthly premiums and copayments. Since 1982, copayments have been limited to a nominal amount of no more than $3, in most cases.
Although median family income today tops $43,000 and a stamp costs 37 cents, Medicaid’s copayments are effectively frozen in 1982 – when median family income was just over $20,000 and a stamp was 20 cents.
Many of Medicaid’s fiercest advocates are already objecting to suggested reforms that would control spending, taking particular exception to increased cost sharing. Such a position defies reality and reason.
Welfare reform successfully restored the idea that government assistance doesn’t come free or without obligation; a concept most Americans understand whether they are working for a paycheck or paying for a doctor visit.
Medicaid reform must tackle the entitlement and provide states the flexibility they need while giving recipients greater responsibility over their lives.
[Matthew Hisrich, "A Backgrounder on Kansas Medicaid," The Flint Hills Center, 19 July 2004.]
New prescription assistance program to become available in Kansas
On Tuesday, Aug. 16, The Partnership for Prescription Assistance will be rolled out in Kansas at the Marian Clinic in Topeka at 10 a.m. This is a private sector effort to assist those most in need in obtaining medicine:
The Partnership for Prescription Assistance brings together America’s pharmaceutical companies, doctors, other health care providers, patient advocacy organizations and community groups to help qualifying patients who lack prescription coverage get the medicines they need through the public or private program that’s right for them. Many will get them free or nearly free. Its mission is to increase awareness of patient assistance programs and boost enrollment of those who are eligible. Through this site, the Partnership for Prescription Assistance offers a single point of access to more than 275 public and private patient assistance programs, including more than 150 programs offered by pharmaceutical companies. To access the Partnership for Prescription Assistance by phone, you can call toll-free, 1-888-4PPA-NOW (1-888-477-2669).
[Matthew Hisrich, "Sebelius Is Practicing Black-Market Politics," The Wichita Eagle, 10 December 2004.]
On Tuesday, Aug. 16, The Partnership for Prescription Assistance will be rolled out in Kansas at the Marian Clinic in Topeka at 10 a.m. This is a private sector effort to assist those most in need in obtaining medicine:
The Partnership for Prescription Assistance brings together America’s pharmaceutical companies, doctors, other health care providers, patient advocacy organizations and community groups to help qualifying patients who lack prescription coverage get the medicines they need through the public or private program that’s right for them. Many will get them free or nearly free. Its mission is to increase awareness of patient assistance programs and boost enrollment of those who are eligible. Through this site, the Partnership for Prescription Assistance offers a single point of access to more than 275 public and private patient assistance programs, including more than 150 programs offered by pharmaceutical companies. To access the Partnership for Prescription Assistance by phone, you can call toll-free, 1-888-4PPA-NOW (1-888-477-2669).
[Matthew Hisrich, "Sebelius Is Practicing Black-Market Politics," The Wichita Eagle, 10 December 2004.]
Wednesday, August 10, 2005
South Carolina: State Sens. Darrell Jackson (D) and Joel Lourie (D) last week sent a letter to Gov. Mark Sanford (R) urging him to withdraw a request for the federal government to approve his Medicaid reform plan, the AP/Charlotte Observer reports (Collins, AP/Charlotte Observer, 8/4).
The state has requested a waiver from the federal government to end Medicaid eligibility for children at age 18 instead of the current age limit of 21, a move that would affect about 25,000 beneficiaries. The state Medicaid program also is seeking federal permission to require copayments of $100 for inpatient hospital visits and $25 for outpatient surgeries for child beneficiaries (Kaiser Daily Health Policy Report, 7/28).
Jackson and Lourie said they had not been given enough time to discuss the changes. However, Sanford spokesperson Joel Sawyer said information on the proposed changes had been available since October 2004 (AP/Charlotte Observer, 8/4).
Business Week on Monday examined Sanford's requested reforms and the political ramifications of his proposal (Gleckman, Business Week, 8/8)
From the Kaiser Daily Health Policy Report (8/09/2005)
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=31913
The state has requested a waiver from the federal government to end Medicaid eligibility for children at age 18 instead of the current age limit of 21, a move that would affect about 25,000 beneficiaries. The state Medicaid program also is seeking federal permission to require copayments of $100 for inpatient hospital visits and $25 for outpatient surgeries for child beneficiaries (Kaiser Daily Health Policy Report, 7/28).
Jackson and Lourie said they had not been given enough time to discuss the changes. However, Sanford spokesperson Joel Sawyer said information on the proposed changes had been available since October 2004 (AP/Charlotte Observer, 8/4).
Business Week on Monday examined Sanford's requested reforms and the political ramifications of his proposal (Gleckman, Business Week, 8/8)
From the Kaiser Daily Health Policy Report (8/09/2005)
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=31913
Friday, August 05, 2005
Knowing when to say when
["Long-Term-Care Insurance," NCPA Daily Policy Digest, 5 August 2005.]
A recent column from The New York Times is the subject of this entry from today's NCPA Daily Policy Digest. While clearly too few people are covered by long-term health policies, it is still important to act as a wise consumer when weighing the purchase of a plan:
Only 10 percent of people over 65 own long-term-care insurance policies while others say they are intimidated by high costs and the bewildering array of benefit levels, deductible periods and other features, says the New York Times.
These policies protect against improbable events and require a lifetime commitment to one insurer; the good news is that many policies now cover home care, assisted living, respite care and hospice care.
But studies show that only a small percentage of policyholders need care for long periods -- four years or more -- so specialists are recommending policies for which the holder pays a larger share of the costs.
- Only 3.6 percent of claims were for care that lasted for four years and 4.3 percent were for more than five years.
- In 76.7 percent of claims, care lasted less than two years.
- About a third of all policyholders had policies that provided benefits for seven years to a lifetime.
Shorter benefit periods make sense in the four states that offer so-called "partnership policies" that shelter a limited amount of assets, and there are alternatives for married couples, such as joint benefits. Buyers can also save by opting for a longer deductible.
Though the one place not to skimp is inflation protection; only 40 percent of new policyholders buy such protection, says the Times.
[Stephen Moses, "Nursing home system in need of reform," The Pittsburg Morning Sun, 22 May 2005.
Stephen A. Moses, "Project Proposal: Controlling Medicaid Long-Term Care Costs," The Flint Hills Center, January 2004.]
["Long-Term-Care Insurance," NCPA Daily Policy Digest, 5 August 2005.]
A recent column from The New York Times is the subject of this entry from today's NCPA Daily Policy Digest. While clearly too few people are covered by long-term health policies, it is still important to act as a wise consumer when weighing the purchase of a plan:
Only 10 percent of people over 65 own long-term-care insurance policies while others say they are intimidated by high costs and the bewildering array of benefit levels, deductible periods and other features, says the New York Times.
These policies protect against improbable events and require a lifetime commitment to one insurer; the good news is that many policies now cover home care, assisted living, respite care and hospice care.
But studies show that only a small percentage of policyholders need care for long periods -- four years or more -- so specialists are recommending policies for which the holder pays a larger share of the costs.
- Only 3.6 percent of claims were for care that lasted for four years and 4.3 percent were for more than five years.
- In 76.7 percent of claims, care lasted less than two years.
- About a third of all policyholders had policies that provided benefits for seven years to a lifetime.
Shorter benefit periods make sense in the four states that offer so-called "partnership policies" that shelter a limited amount of assets, and there are alternatives for married couples, such as joint benefits. Buyers can also save by opting for a longer deductible.
Though the one place not to skimp is inflation protection; only 40 percent of new policyholders buy such protection, says the Times.
[Stephen Moses, "Nursing home system in need of reform," The Pittsburg Morning Sun, 22 May 2005.
Stephen A. Moses, "Project Proposal: Controlling Medicaid Long-Term Care Costs," The Flint Hills Center, January 2004.]
Thursday, August 04, 2005
Who's on Medicaid?
[Kevin Freking, "Cracks Found in Medicaid Verification," The Las Vegas Sun, 3 August 2005.]
A new report from the Department of Health and Human Services indicates that states may be paying Medicaid benefits out to noncitizens:
A majority of states don't verify claims of U.S. citizenship by those seeking Medicaid, which creates the potential for illegal immigrants to access the health care program, an inspector general's report has found.
"The quality assurance checks aren't there. That's how we see it," said Jodi Nudelman, an acting regional inspector general for the Department of Health and Human Services. "And it's our sense the people may not be aware of that."
The Centers for Medicare and Medicaid Services responded that it agreed that states should have systems in place to ensure the citizenship of applicants. However, it also noted that the IG's report raises only a potential problem.
In some cases, newly arrived legal immigrants, as well as illegal immigrants, can lawfully access Medicaid, but such coverage is greatly limited to emergency care.
[Kevin Freking, "Cracks Found in Medicaid Verification," The Las Vegas Sun, 3 August 2005.]
A new report from the Department of Health and Human Services indicates that states may be paying Medicaid benefits out to noncitizens:
A majority of states don't verify claims of U.S. citizenship by those seeking Medicaid, which creates the potential for illegal immigrants to access the health care program, an inspector general's report has found.
"The quality assurance checks aren't there. That's how we see it," said Jodi Nudelman, an acting regional inspector general for the Department of Health and Human Services. "And it's our sense the people may not be aware of that."
The Centers for Medicare and Medicaid Services responded that it agreed that states should have systems in place to ensure the citizenship of applicants. However, it also noted that the IG's report raises only a potential problem.
In some cases, newly arrived legal immigrants, as well as illegal immigrants, can lawfully access Medicaid, but such coverage is greatly limited to emergency care.
Wednesday, August 03, 2005
Clinton backs vouchers for Medicaid
[Dana Milbank, "The Reformer and the Gadfly Agree on Health Care," The Washington Post, 22 July 2005.]
With a presidential run not too far off, healthy skepticism is likely to greet Senator Hillary Clinton's embrace of a concept touted primarily on the right. Nonetheless, even if it is simply her political ambitions that lead to the implementation of sound public policy, sound public policy would still be a big improvement:
The budding friendship between Hillary and Newt -- yesterday's meeting was their second such joint appearance -- offers some political rehab for both. Clinton, pariah of the right, wants to show moderation as she prepares for a likely presidential run. Gingrich, pariah of the left, wants to show moderation to earn status as an elder statesman.
But whatever the self interest, yesterday's "Ceasefire" session, sponsored by Pfizer, coordinated by American University and moderated by former senator John Breaux (D-La.), was hopeful. If there is agreement between Clinton, who led the Democrats' doomed health care initiative in 1993, and Gingrich, who used the debacle to gain GOP control of Congress, then there may be relief yet for the 40 million uninsured Americans.
[Clinton] nodded in support of Gingrich's proposal to "voucherize Medicaid" and agreed with his statement that "welfare reform has really worked." She granted that "there is enough money in the system right now to cover the uninsured" and she said that piecemeal reform was the best route.
[Matthew Hisrich, "The Uninsured in Kansas – a Closer Look," The Flint Hills Center, 28 July 2005.
Devon M. Herrick, "Give Medicaid recipients more control," The Wichita Eagle, 3 March 2005.]
[Dana Milbank, "The Reformer and the Gadfly Agree on Health Care," The Washington Post, 22 July 2005.]
With a presidential run not too far off, healthy skepticism is likely to greet Senator Hillary Clinton's embrace of a concept touted primarily on the right. Nonetheless, even if it is simply her political ambitions that lead to the implementation of sound public policy, sound public policy would still be a big improvement:
The budding friendship between Hillary and Newt -- yesterday's meeting was their second such joint appearance -- offers some political rehab for both. Clinton, pariah of the right, wants to show moderation as she prepares for a likely presidential run. Gingrich, pariah of the left, wants to show moderation to earn status as an elder statesman.
But whatever the self interest, yesterday's "Ceasefire" session, sponsored by Pfizer, coordinated by American University and moderated by former senator John Breaux (D-La.), was hopeful. If there is agreement between Clinton, who led the Democrats' doomed health care initiative in 1993, and Gingrich, who used the debacle to gain GOP control of Congress, then there may be relief yet for the 40 million uninsured Americans.
[Clinton] nodded in support of Gingrich's proposal to "voucherize Medicaid" and agreed with his statement that "welfare reform has really worked." She granted that "there is enough money in the system right now to cover the uninsured" and she said that piecemeal reform was the best route.
[Matthew Hisrich, "The Uninsured in Kansas – a Closer Look," The Flint Hills Center, 28 July 2005.
Devon M. Herrick, "Give Medicaid recipients more control," The Wichita Eagle, 3 March 2005.]
Tuesday, August 02, 2005
While some governors find innovative solutions to Medicaid, Sebelius remains committed to bad ideas
[John Hanna, "Sebelius will continue to push health care proposals," Associated Press, The Kansas City Star, 1 August 2005.
Regina E. Herzlinger and Tom Nerney, "Medicine for Medicaid," The Wall Street Journal, 2 August 2005.]
Amazingly, Governor Sebelius insists on continuing to push her tobacco tax as a way to avoid real reform of Medicaid.
Last year, Sebelius proposed increasing tobacco taxes by $50 million to extend Medicaid and other state coverage to an additional 70,000 Kansans, plus subsidize private plans for an additional 30,000. The tax on cigarettes would have increase 50 cents a pack, to $1.29, while the tax on other tobacco products would have jumped to 15 percent from 10 percent.
Legislators never seriously debated her proposal, but Sebelius said she hadn't abandoned it.
"I think a user tax to pay for additional health care makes wonderful sense to me and makes wonderful sense to a lot of Kansans," she said.
But House Speaker Doug Mays said increasing tobacco taxes would do little to deal with the state's rising Medicaid costs, which have more than tripled over the past decade to more than $1.4 billion annually.
"If we don't begin looking at this problem and figuring out a course of action, we're going to be in deep trouble within a matter of three to five years," Mays said.
The contrast with leaders in other states is incredible:
On Medicaid's 40th anniversary -- just upon us -- some visionary governors are showing how chopping the $300 billion spent on the joint federal-state program for 53 million poor and disabled Americans is not the only solution to its staggering costs.
Three characteristics are central to such programs: (1) liberating enrollees to manage their own health care purchases; (2) freeing providers to design innovative care programs, tailored for the unique needs of the recipients; and (3) enabling intelligent choice with new information and support. For example, South Carolina Gov. Mark Sanford's plan would liberate recipients with a budget sufficient to meet their particular health care needs, a catastrophic health insurance policy, and free preventive care. Enrollees could roll over unexpected annual funds. He would enable intelligent choice by transforming the Medicaid agency from a health care purchaser and micro-manager to an educator and facilitator. Jeb Bush's consumer-driven Medicaid program frees supply by encouraging innovations such as provider-sponsored, community-based health service systems.
Some Congressional solons decry plans that include freeing the federal chokehold on innovative state Medicaid programs. Bad mistake. The best cure for Medicaid's budget woes -- and the best medicine for its beneficiaries -- are market-based innovations by prescient governors.
[Matthew Hisrich, "Kansas needs bold Medicaid reform," The Wichita Eagle, 21 January 2004.]
[John Hanna, "Sebelius will continue to push health care proposals," Associated Press, The Kansas City Star, 1 August 2005.
Regina E. Herzlinger and Tom Nerney, "Medicine for Medicaid," The Wall Street Journal, 2 August 2005.]
Amazingly, Governor Sebelius insists on continuing to push her tobacco tax as a way to avoid real reform of Medicaid.
Last year, Sebelius proposed increasing tobacco taxes by $50 million to extend Medicaid and other state coverage to an additional 70,000 Kansans, plus subsidize private plans for an additional 30,000. The tax on cigarettes would have increase 50 cents a pack, to $1.29, while the tax on other tobacco products would have jumped to 15 percent from 10 percent.
Legislators never seriously debated her proposal, but Sebelius said she hadn't abandoned it.
"I think a user tax to pay for additional health care makes wonderful sense to me and makes wonderful sense to a lot of Kansans," she said.
But House Speaker Doug Mays said increasing tobacco taxes would do little to deal with the state's rising Medicaid costs, which have more than tripled over the past decade to more than $1.4 billion annually.
"If we don't begin looking at this problem and figuring out a course of action, we're going to be in deep trouble within a matter of three to five years," Mays said.
The contrast with leaders in other states is incredible:
On Medicaid's 40th anniversary -- just upon us -- some visionary governors are showing how chopping the $300 billion spent on the joint federal-state program for 53 million poor and disabled Americans is not the only solution to its staggering costs.
Three characteristics are central to such programs: (1) liberating enrollees to manage their own health care purchases; (2) freeing providers to design innovative care programs, tailored for the unique needs of the recipients; and (3) enabling intelligent choice with new information and support. For example, South Carolina Gov. Mark Sanford's plan would liberate recipients with a budget sufficient to meet their particular health care needs, a catastrophic health insurance policy, and free preventive care. Enrollees could roll over unexpected annual funds. He would enable intelligent choice by transforming the Medicaid agency from a health care purchaser and micro-manager to an educator and facilitator. Jeb Bush's consumer-driven Medicaid program frees supply by encouraging innovations such as provider-sponsored, community-based health service systems.
Some Congressional solons decry plans that include freeing the federal chokehold on innovative state Medicaid programs. Bad mistake. The best cure for Medicaid's budget woes -- and the best medicine for its beneficiaries -- are market-based innovations by prescient governors.
[Matthew Hisrich, "Kansas needs bold Medicaid reform," The Wichita Eagle, 21 January 2004.]
Medicaid reaches historic proportions
[Dennis Cauchon, "Medicaid insures historic number," USA TODAY, 1 August 2005.]
USA Today calls attention to the incredible growth of Medicaid nationally in this recent article:
The nation has so vastly extended taxpayer-funded Medicaid to the working poor this decade that it has produced the biggest expansion of a government entitlement since the Great Society was launched in the 1960s, a USA TODAY analysis has found.
With little notice, the medical care program paid by federal and state taxpayers has grown from covering 34 million people in 1999 to 47 million in 2004, an examination of government data shows.
Today, a family of four can earn as much as $40,000 a year in most states and get government health insurance for children. The nation's median household income was $43,318 in 2003, the Census Bureau says.
Medicaid spending grew from $159 billion in 1997 to $295 billion in 2004. That 85% increase is nearly twice the rise in Medicare, which insures seniors. Washington pays 59% of Medicaid's cost; states pay the rest.
Critics of Medicaid's expansion say it is adding to the federal budget deficit - $412 billion in 2004 - and luring people from employer-offered insurance.
"Shame on us for creating perverse incentives that cause people to give up private coverage for Medicaid," says Michael Cannon, director of health care studies at the libertarian Cato Institute in Washington.
[Matthew Hisrich, "Medicaid could swamp state budget," The Wichita Eagle, 26 July 2005.]
[Dennis Cauchon, "Medicaid insures historic number," USA TODAY, 1 August 2005.]
USA Today calls attention to the incredible growth of Medicaid nationally in this recent article:
The nation has so vastly extended taxpayer-funded Medicaid to the working poor this decade that it has produced the biggest expansion of a government entitlement since the Great Society was launched in the 1960s, a USA TODAY analysis has found.
With little notice, the medical care program paid by federal and state taxpayers has grown from covering 34 million people in 1999 to 47 million in 2004, an examination of government data shows.
Today, a family of four can earn as much as $40,000 a year in most states and get government health insurance for children. The nation's median household income was $43,318 in 2003, the Census Bureau says.
Medicaid spending grew from $159 billion in 1997 to $295 billion in 2004. That 85% increase is nearly twice the rise in Medicare, which insures seniors. Washington pays 59% of Medicaid's cost; states pay the rest.
Critics of Medicaid's expansion say it is adding to the federal budget deficit - $412 billion in 2004 - and luring people from employer-offered insurance.
"Shame on us for creating perverse incentives that cause people to give up private coverage for Medicaid," says Michael Cannon, director of health care studies at the libertarian Cato Institute in Washington.
[Matthew Hisrich, "Medicaid could swamp state budget," The Wichita Eagle, 26 July 2005.]
S. Carolina Medicaid reform moving forward
[Howard Gleckman, "Radical Surgery For Medicaid?", Business Week, 8 August 2005.]
Mike Bond - who addressed legislators here in Kansas on Medicaid reform last year - is finding a more receptive audience elsewhere. The good news is there is still plenty of opportunity for Kansas policymakers to take a leadership role:
The 40th anniversary of Medicaid is on July 30, but few will celebrate. The state and federal program that provides essential health benefits for the poor is in big trouble across the country -- under fire for providing often substandard care even as it breaks the budgets of many states. Now, in what could be the first step toward a fundamental remaking of the huge public program, South Carolina's Republican governor, Mark Sanford, has quietly asked the federal government for permission to redesign Medicaid for the 800,000 low-income residents of his poor, largely rural state.
Under Sanford's proposal, Medicaid would be dramatically transformed. It would no longer provide unlimited care, instead offering beneficiaries -- mostly mothers with children -- a fixed amount of money each year to buy insurance and pay out-of-pocket costs. If they run through their accounts, they would have to pay for additional care on their own. But if they hold spending down, they could bank the leftover money to pay future medical costs -- or even use it to buy private insurance if they leave the program. "This is the biggest change ever for Medicaid," says Cleveland State University finance professor Michael Bond, who helped design the plan.
The Centers for Medicare & Medicaid Services, which oversees Medicaid, already backs the concept. "These kinds of approaches can lead to lower costs and more effective treatment," says CMS director Mark B. McClellan. "You can't treat chronic illness without active patient involvement. And you can't get that through some government pricing program."
The jury is still out on whether health accounts -- which are increasingly common in the employer setting -- can save money or improve care. But with Medicaid costs threatening to overwhelm his budget, Sanford is willing to roll the dice on private accounts. And if, as anticipated, the feds give him the O.K., expect other governors to follow suit.
[Michael Bond and Matthew Hisrich, "Medicaid Lessons from Former Communists," WIBA Newsletter, February 2005.]
[Howard Gleckman, "Radical Surgery For Medicaid?", Business Week, 8 August 2005.]
Mike Bond - who addressed legislators here in Kansas on Medicaid reform last year - is finding a more receptive audience elsewhere. The good news is there is still plenty of opportunity for Kansas policymakers to take a leadership role:
The 40th anniversary of Medicaid is on July 30, but few will celebrate. The state and federal program that provides essential health benefits for the poor is in big trouble across the country -- under fire for providing often substandard care even as it breaks the budgets of many states. Now, in what could be the first step toward a fundamental remaking of the huge public program, South Carolina's Republican governor, Mark Sanford, has quietly asked the federal government for permission to redesign Medicaid for the 800,000 low-income residents of his poor, largely rural state.
Under Sanford's proposal, Medicaid would be dramatically transformed. It would no longer provide unlimited care, instead offering beneficiaries -- mostly mothers with children -- a fixed amount of money each year to buy insurance and pay out-of-pocket costs. If they run through their accounts, they would have to pay for additional care on their own. But if they hold spending down, they could bank the leftover money to pay future medical costs -- or even use it to buy private insurance if they leave the program. "This is the biggest change ever for Medicaid," says Cleveland State University finance professor Michael Bond, who helped design the plan.
The Centers for Medicare & Medicaid Services, which oversees Medicaid, already backs the concept. "These kinds of approaches can lead to lower costs and more effective treatment," says CMS director Mark B. McClellan. "You can't treat chronic illness without active patient involvement. And you can't get that through some government pricing program."
The jury is still out on whether health accounts -- which are increasingly common in the employer setting -- can save money or improve care. But with Medicaid costs threatening to overwhelm his budget, Sanford is willing to roll the dice on private accounts. And if, as anticipated, the feds give him the O.K., expect other governors to follow suit.
[Michael Bond and Matthew Hisrich, "Medicaid Lessons from Former Communists," WIBA Newsletter, February 2005.]
Monday, August 01, 2005
Is there new hope for Medicaid reform in Kansas?
New state legislator Kay Wolf of District 21 listed Medicaid as a key issue facing the Legislature, according to the Associated Press.
On Friday, July 29, the Johnson County Republican committee selected Wolf to replace Rep. Dean Newton as District 21’s state representative. Newton vacated his seat officially on July 22 to serve as a Vice President for Delta Dental of Kansas.
In addition to Medicaid, Rep. Wolf of Prairie Village also listed school funding and the budget as key issues facing the Legislature.
New state legislator Kay Wolf of District 21 listed Medicaid as a key issue facing the Legislature, according to the Associated Press.
On Friday, July 29, the Johnson County Republican committee selected Wolf to replace Rep. Dean Newton as District 21’s state representative. Newton vacated his seat officially on July 22 to serve as a Vice President for Delta Dental of Kansas.
In addition to Medicaid, Rep. Wolf of Prairie Village also listed school funding and the budget as key issues facing the Legislature.
