Here is what looks to be an unintended consequence of the federal health care reform law. The Chicago Sun-Times Abdon M. Pallasch reports that, “The federal government is refusing to allow a new process passed by bipartisan majorities in Illinois that requires medical patients here to show that they live in Illinois and earn little enough to qualify for Medicaid.” The federal Center for Medicare & Medicaid Services is saying no because (more…)
The Wisconsin state legislature did away with two major attempts by Gov. Scott Walker to privatize local administration of federally-funded social services. Jessica Vanegreen of the Madison Capital Times reports that Walker had wanted to use private workers to run Wisconsin’s food stamp program, Food Share, and also to run Medicaid. Walker’s idea was that residents would no longer apply in person for Food Share or Medicaid services, but instead use hotline numbers. The Obama administration threatened to remove federal funding if these proposals got enacted.
But even when Walker loses, he partly wins. The state legislature did agree to consolidate staff at centers that administer food stamp benefits.
House Republicans ultimately failed to include a ban on federal Medicaid funding for Planned Parenthood in the last-minute 2011 federal budget. But the Republican effort to deny Medicaid funds to Planned Parenthood Medicaid lives on at the state level, particularly in Indiana. As Wisconsin did with public employee unions, Indiana Republicans have used state government as a laboratory to weaken Democratic-leaning institutions. (more…)
When not searching the couch cushions and glove compartment for loose change, Illinois Gov. Pat Quinn tends to make controversial proposals to ensure his state pays overdue Medicaid bills — and therefore keeps getting millions in federal Medicaid funds. First, Quinn wanted the state to borrow $8.75 billion, but the state legislature was cool to the idea. Now, the Springfield State Journal Register’s Dean Olsen reports that Quinn wants the Illinois Finance Authority to borrow $750 million from private investors like banks and then repay the banks with interest.
Given the state’s massive short and long-term deficit, further borrowing sounds bad. But other alternative to make state payments are worse: like freezing state income tax money that goes to municipal governments (many of which, like Chicago, are doing just as badly as the state).
In assessing Paul Ryan’s ballyhooed deficit reduction/entitlement reform budget plan, reporters have mainly looked at the end of Medicare as we know it. But the most dramatic change is Medicaid, the federal/state program for the poor and disabled, changing from an entitlement to block grant program. Micah Maidenberg of Progress Illinois reports numbers provided from the Center for Budget & Policy Priorities that had the Ryan plan been effect between 2000 and 2009, Illinois would have lost $9.3 billion total in federal medicaid funds — or about 1/3 of the state’s annual budget. (more…)
Gov. Pat Quinn wants Illinois to borrow $2 billion in order to pay for the state’s Medicaid program, reports Yvette Shields at Bond Buyer. At issue are two facts: A.) Illinois has a colossal, monstrous, record short-term deficit even with a major tax increase and B.) the federal reimbursement rate for Medicaid costs drops from 57 percent to 50 percent July 1st, when the stimulus bill extension expires.
Enrollment in Medicaid jumped during the Great Recession, but until now the increased federal reimbursement covered this cost. Absent this borrowing, it’s not clear what the state can do besides cut other programs or reduce Medicaid services. They can’t really reduce eligibility levels: A reduction would deny Illinois heavy federal Medicaid subsidies that start in 2014 under the national health care reform law.
Micah Maidenberg of Progress Illinois reports on implementation of an Illinois law to curb Medicaid costs. Maidenberg finds instances of waste and inefficiencies in the system, like the federal and state government paying an insurance company $243 million between 2000-2004 to participate in Medicaid. The insurance company then didn’t provide health care to pregnant women or unhealthy patients.
But the big picture problem is that, thanks to the recession, both more poor people in Illinois are Medicaid eligible and fewer federal and state dollars are available to provide health services. This dilemma will likely end in 2014 when, under the national health care reform law, the federal government will pay for the health care of every adult who lives at less than 133 percent above the poverty level.
After hearing screams from local officials that decay and blight will spread across the state if redevelopment agencies are dissolved, Medi-Cal advocates are now employing every argument short of “death panels” to blunt proposed cuts to the federal-state program known elsewhere as Medicaid.
According to a comprehensive look presented by Christina Jewett in CaliforniaWatch, supporters of the program are warning that a proposed hard cap of 10 doctor or clinic visits a year is a “death sentence” for California’s sick and poor. (more…)
Kathleen Sebelius
The New York Times’ Robert Pear reports on a letter that Health & Human Services Sec. Kathleen Sebelius wrote to governors on controlling Medicaid costs. In the letter, Sebelius discusses how the Obama administration has helped cash-strapped states through a stimulus bill that increased the federal contribution toward Medicaid. Any stimulus money, though, expires June 2011. And a big potential cost saver for governors — simply cutting people off the Medicaid rolls — would disqualify their states from greatly-expanded federal Medicaid funding in 2014 when the national health care reform law kicks in. So what should states like Illinois, which has a $15 billion budget deficit, do in the interim?
Well, Sebelius suggest a series of cost-saving measures. I and others have pointed out that there’s little fat to trim in Medicaid, at least in Illinois. (more…)
Kevin Sack of the New York Times reports that state governors have proposed major cuts in Medicaid as a way to reduce their state budget deficits — but federal regulations essentially don’t let states cut eligibility levels. Only one state, Arizona, has so far asked the U.S. Dept. of Health & Human Services if it can reduce the number of eligible patients. States like California and New York instead will have the same number of Medicaid patients, who are mostly low-income children and the disabled, but give them reduced services, such as fewer doctors visits per year.
I reported on the Medicaid financing crisis in Illinois and Wisconsin recently, and I think Sack doesn’t make it clear enough how closely bound this topic is to the national health care reform law. (more…)
