Medicaid

There's A Reason "Bend It Like Sebelius" Never Became A Catchphrase

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Looking to fix the state budget mess? Medicaid is a good place to start. Enrollment in the joint federal-state program, which is designed to serve low-income individuals, is way up, and as a result, so are expenses. Even Obama's Health and Human Services Secretary Kathleen Sebelius has noted that states across the country are facing "extraordinary budget challenges" and has implicitly acknowledged the big budget crunch that has implications for Medicaid. But the suggestions offered so far by Sebelius about how to increase efficiency don't amount to much. According to Indiana Gov. Mitch Daniels, they're effectively "meaningless."

As I wrote last week, one of the biggest hurdles to reform right now is that states don't have the flexibility to make changes they might want to make—like, for example, this proposal to shift millions of Texas Medicaid recipients into private insurance. The Dallas Morning News reports:

Texas should shift many of its 3.3 million Medicaid recipients into private health insurance to avert a fiscal meltdown, a conservative group is urging.

Medicaid recipients who are not disabled should be given subsidies to buy private plans, and the state should ask to be freed from federal rules setting minimum coverage levels, the Texas Public Policy Foundation says in a report scheduled for release Tuesday.

The arrangement would let people in the state-federal program "make their own decisions," and all but the most abject of the poor should be forced to use some of their own money so they become more aware of health care's cost, the foundation urged.

"We would make shoppers out of our Medicaid recipients so they are making value decisions," the foundation's executive director, former Rep. Arlene Wohlgemuth, said in an interview.

…"We're going to allow the marketplace to work," Wohlgemuth said. To avoid "frightening" some 820,000 elderly and disabled people now on the program, she said, the plan would keep current benefits and eligibility. But it would slash how much future applicants seeking long-term care could make in income by nearly 40 percent and clamp down on their ability to keep what can be quite valuable homes. And that program also would shift eventually to a market-oriented look, Wohlgemuth said.

But as the article notes, it's not clear that the Obama administration would approve an overhaul of this sort. Certainly, the administration has failed—despite repeated requests—to approve Gov. Daniels' request to use his state's Healthy Indiana Program, a Medicaid waiver program that expands coverage through high-deductible plans, as the vehicle for Indiana's Medicaid expansion as expected under last year's health care overhaul.

It's true that last week the Department of Health and Human Services told officials in Arizona that the state could drop about 250,000 individuals from its Medicaid rolls. But as an article in The Hill pointed out this morning, that was a special circumstance.

The Arizona case is unique, however, and it's not clear if other states will be able to replicate it. For one thing, it operates its Medicaid program under a temporary waiver that expires before 2014, and it's not clear how many other states are in the same boat; in addition, states must meet federal minimum levels regardless of waivers.

So HHS didn't actually issue Arizona a waiver to reduce enrollment. Instead, HHS simply said that, under the existing rules, they couldn't do anything to prevent Arizona from shrinking its program. For all the states that do need waivers in order to make their programs work, this is hardly a promising sign—which may help explain why legislators in Florida are now threatening to pull the state out of the program entirely. I wouldn't necessarily bet that Florida follows through on the threat. Texas made similar noises about dropping out last year and has since backed off somewhat. But it's still notable that it's being talked about as a viable option at all.

NEXT: Down with Gene Tyranny!

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  1. For all the states that do need waivers in order to make their programs work, this is hardly a promising sign?which is why legislators in Florida are now threatening to pull the state out of the program entirely. I wouldn’t necessarily bet that Florida follows through on the threat. Texas made similar noises about dropping out last year and has since backed off somewhat. But it’s still notable that it’s being talked about as a viable option at all.

    Well! Yet another back door bailout for states that have no qualms sucking the federal teat. Right CA, IL and NY? They, like the other states, will take what more responsible states eschew.

    1. Yes, but once states are committed to not sucking the teat, their contempt for those that do will only grow. What will happen? Who knows, but it will be fun to watch at a distance.

  2. “Medicaid recipients who are not disabled should be given subsidies to buy private plans, and the state should ask to be freed from federal rules setting minimum coverage levels, the Texas Public Policy Foundation says in a report scheduled for release Tuesday.

    The arrangement would let people in the state-federal program “make their own decisions,” and all but the most abject of the poor should be forced to use some of their own money so they become more aware of health care’s cost, the foundation urged.”

    The only problem with this is that when you let people “make their own decisions” about health care, they’ll make the same decision Ayn Rand did–they’ll assume they’ll live forever in perfect health (and won’t get caught cheating on their spouse). So when they get cancer what do we do? I guess that isn’t our problem.

    1. Re: Alan Vanneman,

      The only problem with this is that when you let people “make their own decisions” about health care, […] they’ll assume they’ll live forever in perfect health[.]

      God forbid people are allowed to choose. They should be enslaved for their own good.

      So when they get cancer what do we do? I guess that isn’t our problem.

      No, it isn’t. It’s their problem.

      1. No, it isn’t. It’s their problem.

        Rand made it ours

        1. Nope, she merely claimed what the government told her she had been paying taxes for all those years. Being a best-selling author, she probably paid plenty in taxes – especially living in New York.

    2. “So when they get cancer what do we do? I guess that isn’t our problem.”

      Isn’t it social benefit enough for an Objectivist to be forced to choose between dying painfully for her principles or betraying everything she believes in and seeking charity?

    3. Alan Vanneman, you are precisely correct-they are guilty of their own magical thinking/unicorn meme

    4. Bare minimum catastrophic insurance would cover most of the high cost of treating cancer. The rest is likely to be written off, or at worst, be sold to a collection agency and go on your credit report. But I’m sure you knew that.

      1. Fatty Bolger, your remark is indicative of your knowledge on how catastrophic insurance is implemented-I will write about it soon.

        There is a reason why it is not common

  3. There’s A Reason “Bend It Like Sebelius” Never Became A Catchphrase

    Res ipsa Sebilius loquitur

    1. Ave Sebilius! Morituri te salutamus!

  4. Let me be clear: I’ve got something she can bend.

  5. “be forced to use some of their own money so they become more aware of health care’s cost”

    You heartless bastard! Do you want to turn this country into a third-world oligarchy, with children and old people dying in the streets?

  6. There’s a simple solution that you people who hate the poor would never think of. Why don’t we increase the top tax rate to 80% to pay for Medicaid?

    The poor need that money more than the rich people do.

    1. The poor need that money more than the rich people do.

      Pony up first. You yourself said “poor people are icky.”

      1. I’m not rich.

        1. Compared to the “icky poor” I will bet dollars to donuts you are. Pony up.

          1. Sockpuppets can only pay in spoof dollars.

        2. Tony|2.16.11 @ 1:11PM|#
          Actually I happened to be born into a well-off family…

          1. What this site REALLY needs is a Tonypedia, a compendium of Tony’s Greatest Hits.

    2. What’s your reason for stopping at 80%? Why not 100%, you heartless bastard?

    3. Re: Tony,

      There’s a simple solution that you people who hate the poor would never think of.

      You mean the icky people that buy at Walmart?

      Why don’t we increase the top tax rate to 80% to pay for Medicaid?

      Because the magic fountain of revenue does not work linearly, nitwit.

      The poor need that money more than the rich people do.

      And once the rich become poor, then what?

      1. Blimey, this redistribution of wealth is trickier than I though.

    4. I’ll assume that “rich” means “anyone who makes $1 more than I do”

    5. Tony|2.18.11 @ 7:15PM|#

      Well poor people are icky, that’s objective fact.

    6. Eighty cents on EVERY dollar? Why stop there?

    7. Da, da, fake Tony. This is why we always had free health care for everybody!

    8. Highest tax bracket dollars are also the most likely to be used for investment instead of consumption, since we’re talking about people that already have all their basic needs met.

      Even a fucking Commie would be thinking in terms of replacing private sector investment with centrally controlled investment. You’re basically saying we should sell off our entire private sector infrastructure and put everyone out of work to give the beggar class more coke and hookers money.

      I guess that explains why you were born into a well-off family, yet are not rich.

    9. The poor need that money more than the rich people do.

      Who gives a fuck what they “need”? Need is not a moral claim to anything.

  7. But as the article notes, it’s not clear that the Obama administration would approve an overhaul of this sort.

    Maybe the reason is because the Obama administration never had the intention to overhaul the system in any sort of way. Maybe they simply want to overwhelm the system towards the arms of a single-payer system.

    You know, the one without the “death panels”:

    http://www.nationalpost.com/ne…..story.html

  8. People who get kicked off medicaid won’t be “using some of their money” to buy insurance, they will just wait until they are really, really sick and show up at the ER.

    1. they will just wait until they are really, really sick and show up at the ER.

      EMTALA. It all comes back to EMTALA.

  9. Here in Tennessee, even after Bredesen booted more than 350,000 people from TennCare’s rolls, staving off a state budget crisis, all that may have been accomplished is to delay the inevitable.

    Under Obama’s new Medicare rules, the program may need to accommodate 500,000 newly eligible residents beginning in 2014, potentially making TennCare the state’s insurer for 1 out of every 3 Tennesseans.

    ONE OUT OF EVERY THREE.

    But don’t you dare call it a government takeover of healthcare!

    1. You free market fundamentalist!!!

    2. Here in Tennessee, even after Bredesen booted more than 350,000 people from TennCare’s rolls, staving off a state budget crisis, all that may have been was accomplished is was to delay the inevitable.

      🙂

  10. According to Indiana Gov. Mitch Daniels, they’re effectively “meaningless.”

    Would that be the Mitch Daniels who just caved to the unionistas and fleebaggers in Indiana?

    Why, yes, yes, it is!

    Dead. To. Me.

    1. This is the best time in a long time to make a stand. If you cave, you may fuck off now, please. Thank you very much.

      1. I guess we can add Indiana to that list of state accepting back door bailouts.

        I don’t want to see “president” and “Daniels” in the same sentence again.

        We’re so screwed.

        1. Wow, that’s incredibly stupid. It’s not like any of them are ever going to vote for him, anyway.

    2. Yeah, I don’t get this. In 2005 Mitch actually stripped state workers of their collective bargaining rights, I don’t understand why he wants to cave on this now.

    3. I hadn’t seen this. Could Drudge be too depressed about it to put it on his site?

  11. To avoid “frightening” some 820,000 elderly and disabled people now on the program, she said, the plan would keep current benefits and eligibility.

    Yes, we wouldn’t want to frighten the elderly. They clearly had nothing to do with our current economic situation. Let others continue to pay for the “greatest generation” of thieves.

    1. Well either that – or they can move in with their kids. 🙂

  12. the poor should be forced to use some of their own money so they become more aware of health care’s cost

    Dumbass post of the day. The poor already know the cost of fucking health care-It is the cadillac insured who don’t have the least clue, along with anyone else who has private coverage

    1. They were talking about Medicaid recipients, not the uninsured. Co-pays and other cost sharing methods under Medicaid are a lot lower than you get with most insurance plans.

      1. I was speaking of Medicaid and the fact that medical care is so prohibitive that the working poor seek out the service for treatment.

        Not every person is born into Medicaid

        1. With CHIP, you would be surprised.

    2. Weird, I actually agree with you. Are you sure you aren’t a spoofer that forgot to change your name back?

      Third-party payment is the problem, whether it’s fancy insurance for the well-off or government programs for the poor.

      And even there, you can take moderate measures to fix it, you don’t have dismantle it. Make the doctor and the insurer deal with the patient rather than each other (so the patient has to say “Insurance company, I just got my bill for the doctor. Could you please pay me… let’s see here… holy shit! How the fuck are they justifying these fees?”.

      Institute moderate copays that don’t cap out.

      Treat the expected minor stuff as pre-payment rather than insurance, and give cash back to people that don’t actually consume services so they don’t feel like they’re getting ripped off if they don’t waste medical labor on evaluating every little sniffle they have. And yeah, that basically turns everything into major medical by the backdoor, but so be it.

      1. It is me, and I have written about HC reform on my blog too.

        I maintain that the problem with HC reform is not those who abuse the system because we will always have deceit under any system. The catalyst to change will be when the comfortably insured refuse their employer’s coverage, and go ‘free market’ themselves. Any improvement will be through the privately insured.

        My beef with the Libertarian’s view of Health care is that they go for the ‘fuck the poor’ approach without putting their own house in order. How many of these free market advocates keep employee’s insurance? Reason’s writers are covered under their employment insurance, and fail to see the irony

        1. Narcissistic personality disorder

          U.S. National Library of Medicine
          National Institutes of Health
          National Center for Biotechnology Information
          U.S. National Library of Medicine
          National Institutes of Health

          Narcissistic personality disorder is a condition in which people have an inflated sense of self-importance and an extreme preoccupation with themselves.
          Causes, incidence, and risk factors

          The causes of this disorder are unknown. An overly sensitive personality and parenting problems may affect the development of this disorder.

          Symptoms

          A person with narcissistic personality disorder may:

          * React to criticism with rage, shame, or humiliation

          * Take advantage of other people to achieve his or her own goals

          * Have excessive feelings of self-importance

          * Exaggerate achievements and talents

          * Be preoccupied with fantasies of success, power, beauty, intelligence, or ideal love

          * Have unreasonable expectations of favorable treatment

          * Need constant attention and admiration

          * Disregard the feelings of others, and have little ability to feel empathy

          * Have obsessive self-interest

          * Pursue mainly selfish goals

          Link to my blog.

          1. Well, done. I don’t doubt that your diagnosis is spot on.

  13. In all seriousness, can someone explain to me why this is any different from Medicare Advantage. Why is shoveling the same amount of money through insurers better than straight subsidy? Either way, you still have the same crappy incentives that cause costs to spiral upwards. Insurance companies pushing low-deductible coverage are part of the problem, if not the main problem. (The others would be the asymmetric tax laws that make it so that corporations but not individuals get to write off medical insurance, the general shortage of doctors, overlicensing, and maybe fifteenth, the ease of malpractice lawsuits.)

  14. Here’s a good youtube on the budget: http://www.youtube.com/watch?v=FawyVbB1m-c

    There is also a good reason why there was never a Bend It Like Boehner.

      1. Pity women can’t get that in their tits. 🙂

  15. I’m not sure what the question was, but the answer is, “Both Parminder Nagra and Keira Knightley at the same time.”

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