Medicaid

Looming Cuts to Medicaid Docs "Threaten Access to Care" Sez NY Times

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One of the big ways that Obamacare extends health care coverage is via a massive expansion of Medicaid, which pays for treatment of lower-income Americans. Never known for its swift and effective coverage, the president's health care reform gave extra money to doctors willing to provide primary care to Medicaid recipients. That ends on Thursday and "threatens access to care," according to The New York Times:

The Affordable Care Act provided a big increase in Medicaid payments for primary care in 2013 and 2014. But the increase expires on Thursday — just weeks after the Obama administration told the Supreme Court that doctors and other providers had no legal right to challenge the adequacy of payments they received from Medicaid.

The impact will vary by state, but a study by the Urban Institute, a nonpartisan research organization, estimates that doctors who have been receiving the enhanced payments will see their fees for primary care cut by 43 percent, on average….

The White House says Medicaid is contributing to the "largest coverage gains in four decades," with 9.7 million people added to the Medicaid rolls since October 2013, bringing the total to 68.5 million. More than one-fifth of Americans are now covered by Medicaid.

But federal officials have not set forth a strategy to expand access to care with enrollment, and in many states Medicaid payment rates for primary care services, like routine office visits and the management of chronic illnesses, will plunge back to 2012 levels, widely seen as inadequate….Almost 40 percent of Ohio doctors indicated that they planned to accept fewer Medicaid patients when the extra payments lapsed.

Read the whole thing.

This sets up a political battle to keep the higher level of benefits and it's one that I bet goes in favor of the White House and, ultimately, the doctors who see Medicaid patients. It will be seen as too cruel to yank benefits that were misbegotten in the first place, and don't you know that more money solves all problems?

The selling point of the Medicaid expansion was that the federal government would pick up virtually all of the costs of the expansion through 2019 and then 90 percent after that. It was "free money" that only poor-hating plutocrats could pass up on. Yeah, well, regular Medicaid spending is split between the feds and the states and is already the single-largest budget item in state budgets. One way or another, it's about to become bigger still, because either the feds will squeeze more money out of taxpayers to keep the program going or will off-load more of the costs onto states. After all, it's not as if the feds could promise that the original terms of the deal would last forever. Or even the rest of this week.

A better debate to be having is whether Medicaid contributes to good health outcomes in the first place. For all the money that has been spent on Medicaid since its creation in the late 1960s, a clear positive answer to that question remains elusive. In fact, on a variety of outcomes, it's unambiguous that "health outcomes for patients covered by Medicaid…are actually worse than those covered by no insurance at all."

In 2013, Reason TV caught up with Alieta Eck, M.D. and talked with her about "How Medicaid & Obamacare Hurt the Poor—And How to Fix Them":

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  1. Hey, those folks were given insurance cards, and I was repeatedly told that insurance equals health care.

    1. Not only that, health care is a right. It’s somewhere in the Bill of Rights, right between the free pony amendment and the free birth control amendment.

      1. and next to the section that says you should be able to carry an Uzi into a school.

  2. http://www.salon.com/2014/12/2….._saves_us/ – In the middle of Salon whining about how the Democrats just aren’t socialist enough, they give us a glimpse into the alternate universe inhabited by the left.

    “It took more than the usual civic sloth to produce the lowest turnout in 72 years. It took alienating vast voting blocs, including the young and the working class of both genders and all races. The young now trend Republican. Voters of all ages migrate to third parties or abandon politics altogether. **It’s the biggest Democratic defection since the South switched parties in the 1960s.**”

    1. Oops, didn’t mean to submit.

      Anyway, since when did the south switch to the Republicans in the 1960’s? The real switch didn’t happen until the 80’s. Several southern states were still voting Democrat as recently as the Clinton presidency.

      It’s almost like the left wants to pretend the south immediately became Republican in 1963 so that they can claim the Republicans are at fault for 1960’s southern racism.

      1. It’s almost like the left wants to pretend the south immediately became Republican in 1963 so that they can claim the Republicans are at fault for 1960’s southern racism.

        It’s not that the Republicans are at fault. It’s that they became the racism party to get southern votes. At least that’s what I hear proggies say all the time.

      2. Salons understanding of history may be the only thing worse than their understanding of economics.

        1. It’s like Carter and Clinton didn’t happen. Both of them were elected with many Southern states voting on their behalf.

          And that’s just presidencies. Several southern states were still sending large numbers of congressmen/senators to D.C. even after they started voting Republican for presidents. It’s only in the last decade or so that the Southern Blue Dogs really died off and vanished.

      3. Both sides tend to drastically oversimplify the Southern switch, but the left’s narrative of an immediate mass exodus is laughable. I believe that the only Southern Democrats in Congress in 1964 who ever became Republicans were Strom Thurmond and a congressman from South Carolina who was a close ally of his (the name escapes me).

        1. I believe your thinking of Trent Lott.

          1. I just looked it up and it was Albert Watson. Lott’s from Mississippi and he wasn’t in Congress in 64.

        2. And Robert “Grand Dragon” Byrd remained a strong Democrat until the day he died.

          Hell, he lived long enough to vote for Obamacare!

          1. But he changed!

            *Even though he used the term “white niggers” on national television in the early 2000s.

            1. He was clearly talking about white people, so no harm no foul?

      4. “Though the “Solid South” had been a longtime Democratic Party stronghold due to the Democratic Party’s defense of slavery before the American Civil War and segregation for a century thereafter, many white Southern Democrats stopped supporting the party following the civil rights plank of the Democratic campaign in 1948 (triggering the Dixiecrats), the African-American Civil Rights Movement, the passage of the Civil Rights Act of 1964 and Voting Rights Act of 1965, and desegregation. The strategy was first adopted under future Republican President Richard Nixon and Republican Senator Barry Goldwater in the late 1960s.” Wikipedia – Southern_strategy

        “Political analyst and Nixon campaigner Kevin Phillips, analysing 1948-1968 voting trends, viewed these rebellious Southern voters as ripe for Republican picking. In The Emerging Republican Majority (Arlington House, 1969), he correctly predicted that the Republican party would shift its national base to the South by appealing to whites’ disaffection with liberal democratic racial and welfare policies. President Nixon shrewdly played this “Southern strategy” by promoting affirmative action in employment, a “wedge” issue that later Republicans would exploit to split the Democratic coalition of white working class and black voters. (See John Skrentny, The Ironies of Affirmative Action (U Chicago Press, 1996)). This strategy soon produced the racial party alignments that prevail today” http://www.umich.edu/~lawrace/votetour10.htm

      5. Don’t confuse voting conservative and voting Republican, they have not always been the same thing. Democrats were much more conservative in the south and that has changed. I don’t think it was the people leaving the party but the party leaving the people. Just my take.


    2. Let’s All Screw the 1 Percent

      What about this beauty topping out the “Most Read” column to the right. I love good satire!!

      1. Ah Salon – complaining about people working too hard… Don’t ever change.

      2. That’s stupendous because it misses the actual reason for poor people in America – the unemployed. Unemployment is the primary cause of poverty, not people working long hours.

        Progs ignore this so that they can demagogue about the minimum wage and desperately pretend it will improve the plight of the poor.

        1. That’s because working a shit job is beneath their dignity. Better to sit around doing nothing on the dole.

          1. My first job was shovelling dog shit as a kennel boy while I was in high school.

            At 85? per hour (or $6.27/hr in today’s currency).

            My friends who had no part time jobs were envious.

      3. Last time I put in a lot of overtime, and got paid for it, I was put into a higher tax bracket and ended up taking home very little for my time. Curiously, that situation wasn’t mentioned in the article.

      4. Give the middle class more work hours!! That’ll show the 1%!!!

      5. The sidebar also has another old standby: My horrible right-wing past: Confessions of a one-time religious right icon

        And now I’m tempted to look at Wealth of Nations again and see how horribly they’ve miscast Smith.

  3. That ends on Thursday after the last election during Obama’s term in office and “threatens access to care,” according to The New York Times:

    Quelle coincidence, no?

    Here’s the other bit: lots (and more all the time) of Medicaid is actually in managed care programs, where the insurance companies get paid a “premium” by Medicaid for each person who uses their product. This will mean cuts in those “premiums”, which will in turn reduce, not only reimbursement, but benefits as well.

    Not only will there be fewer providers, there will be fewer covered services as well.

    Tell us again what a success this is, shreek.

    1. Equality is the lowest common denominator. Better for everyone to get substandard care than to allow some people to get good care.

  4. Put em on the much touted exchanges. Everyone should like that solution right?

  5. I’d like to introduce Progressives to this radical new concept just uncovered by scientists. It’s called “the future” and it’s a place where things that we do in the present happen. There’s also this thing called “the past” where we’ve already done things that make “now” what it is.

    It’s a hard sell but it just might work.

    1. See this helpful video for more advice

      http://m.youtube.com/watch?v=5drjr9PmTMA

      1. I’ll send ’em a copy at Ludicrous Speed.

    2. I think the more clever Progs understand that any programs passed in the past can never be undone and can always be shown to be “too little to solve the problem.”

      1. While I think you’re right in general, I don’t think that’s the case here. One of the few conspiracy theories I indulge in is the idea that no one ever meant for the ACA to actually pass. It’s not uncommon to abuse parliamentary procedures to make it look like everyone supported something just for show. By taking out the public option and adding a mandate (which, when first proposed, was backed by jailtime rather than the penaltax) which they said they wouldn’t, they might have been trying to kill any public support. But some of the new congressthings weren’t in on the game and they got stuck with this – and can’t give up supporting it.

        Just a thought, anyway.

        1. I think they realized they didn’t have the votes to get it through with the public option, so they came up with a plan that only a partisan hack could love. They took the public option out and delayed implementation for a few years, confident that voters(especially the FSA) would give them an even bigger majority in the next election,then they could pass the public option separately. When the plebes rebelled they were left with a shit sandwich, but by that time the only choice they had was tool grin and take a big bite.

          1. Probably more likely than my scenario. “Now we need single-payer” was pretty much the rallying cry from then on.

  6. I am shocked that the promised sources of “cost cutting” will never materialize, because politicians never want to be caught voting for ‘less money’ for constituents.

    How could anyone ever have believed that political control of healthcare would result in ‘lower costs’? They will sell everyone on the benefits of expansion, show ‘studies’ suggesting that there are massive cost benefits… but when it comes to execution? no, they’ll throw endless piles of money no matter how ineffective the system because doing otherwise is politically impossible

    Once they get their foot in the door offering ‘free shit’ to people, you can never take the free shit away – because now its a ‘right’

    1. How could anyone ever have believed that political control of healthcare would result in ‘lower costs’?

      Because government doesn’t waste money on profits for rich people. That makes government more efficient. Seriously. I’ve seen that argument more than once.

      1. That, duplication of products, “exploitation” was the main arguments behind original marxism I believe.

        1. “”duplication of products””

          is that a euphemism for ‘competition’?

          Because ‘choice’ is *inefficient!*

          1. Heh, I just had a flashback to the 80’s and shopping for “generic” goods when that became huge for awhile. Black and white packages marked just “Milk” or “Bread”.

          2. In their fucked up worldview, yes.

        2. Because health care is a basic right, it is immoral for the corporations to profit from it. That’s why all health care should be done by the government. Since government doesn’t give profits to rich people, it is the only moral way to provide health care. Doesn’t matter if the care is worse. It’s a moral issue. Profit is theft, and profit from basic needs is that much more immoral.

          1. I don’t even think it was a moral argument for them, at least not originally. It was more about “inefficiency”.

          2. My response to the ‘people shouldn’t profit from providing health care’ argument has always been “You mean Doctors and Nurses should be forced to work for free?”

      2. Seriously.

        Yeah, that’s a pretty universal belief on the left. I remember believing that myself.

        1. I once felt as they do over there on the left.

          Then I learned to think.

      3. Because government doesn’t waste money on profits for rich people. That makes government more efficient. Seriously. I’ve seen that argument more than once.

        Oh, I’ve heard that from someone who got paid out of Gross Profits…

    2. How could anyone ever have believed that political control of healthcare would result in ‘lower costs’?

      I sometimes posed this in even more generic terms to pro-Obamacare friends, viz.

      “Your argument is that we’re going to provide more healthcare to a greater number of people and it will cost less money, correct?”

      1. “Your argument is that we’re going to provide more healthcare to a greater number of people and it will cost less money, correct?”

        Government is magic.

        1. That, and the words “waste and fraud” were tossed around. Apparently there is enough w&f to save the budget. Of course, if you ask how an institution which creates w&f will both cut same and prevent future, it gets tricky.

          1. Any attempts to root out w&f are doomed to failure, since most of it is a result of people and businesses doing what idiot government bureaucrats tell them to do.

            1. Oh, there is definitely fraud committed by private companies, but the amount pales in comparison with the amount of fraud perpetrated in government.

        2. Government is magic.

          It is if you do not believe in Public Choice Theory.

          Seriously. Ask a leftist about Rent Seeking and Regulatory Capture and what cost it has.

          It’s as if corruption only happens inside corporations and not inside government?

  7. Look, all the matters is that the government becomes bigger and makes more people dependent on it, so that it can grow even more. Any pretension about results, etc., are just a side show.

  8. Another thing. Why are all the people being bulldozed over the cliff old? I thought the “free health insurance” for the old was MediCARE. Were they just too lazy to do a new cartoon and repurposed one from a Paul Ryan attack ad?

    1. Why are all the people being bulldozed over the cliff old?

      Sharks gotta eat, too.

  9. It’s this damn doc fix, the “wink and nod” way of funding Medicare.

    “Hey docs, we gotta make the ACA look good for the CBO so that we can get its costs down and get it passed, so we have to cut the reimbursement rates for 2015 but we’ll *wink wink* make sure to do a fix and increase them later. You jake with that?”

    Suckers, AMA.

  10. “One of the big ways that Obamacare extends health care coverage is via a massive expansion of Medicaid, which pays for treatment of lower-income Americans.”

    Technically, Medicaid only pays hospitals about 12.5 cents on the dollar billed while, comparatively speaking, private Aetna pays about 80 cents.

    Doctors get paid by Medicaid a whole lot better than providers, do, that’s for sure–but we should be careful not to give people the impression that “Medicaid pays for the treatment of lower-income Americans”.

    Medicaid pays for a tiny fraction of the treatment of lower-income Americans on the program, and providers recoup the losses they suffer by treating Medicaid patients by gouging private pay patients and patients on private insurance.

    By expanding Medicaid, ObamaCare has exacerbated that problem. That’s why premiums will keep rising. That’s why deductibles have gone through the roof.

  11. OT and for no other reason than sometimes we just need to see things like this:

    http://www.theactivetimes.com/…..-slideshow

  12. The answers are so simple – universal single payer, and if anyone who is thought to be qualified to train and dispense medical care, refuses, their family will be whisked off to northern Alaska to gain compliance from qualified individual.

    It’s the logical end game to the line of reasoning. Health care is a RIGHT! Getting people to do dispense health care are fair trade rates, through coercion if necessary, is where we must head.

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