Our Health Policy Matters

As Congress works through the challenge of changing Obamacare, how the federal government pays its share of Medicaid dollars will be part of the debate. At first, Medicaid was designed primarily to offer to people with chronic conditions the long-term care benefits that Medicare did not. It pays much of our nation’s nursing home bill.  It was later expanded to provide safety net insurance to low income families, especially for women and children. Medicaid is a federal/state partnership program. The states design their own programs within federally-established rules, and the federal government reimburses half (or more) of the state’s cost. The Affordable Care Act added a new wrinkle to the cost-sharing formula.  For those states that expanded the Medicaid program to serve even more people, including uninsured single adults, it offered 90+ percent reimbursement for the new populations.  To date, 32 states have expanded. What’s wrong with Medicaid? Medicaid costs...

As Congress works through the challenge of changing Obamacare, how the federal government pays its share of Medicaid dollars will be part of the debate. At first, Medicaid was designed primarily to offer to people with chronic conditions the long-term care benefits that Medicare did not. It pays much of our nation’s nursing home bill.  It was later expanded to provide safety net insurance to low income families, especially for women and children. Medicaid is a federal/state partnership program. The states design their own programs within federally-established rules, and the federal government reimburses half (or more) of the state’s cost. The Affordable Care Act added a new wrinkle to the cost-sharing formula.  For those states that expanded the Medicaid program to serve even more people, including uninsured single adults, it offered 90+ percent reimbursement for the new populations.  To date, 32 states have expanded. What’s wrong with Medicaid? Medicaid costs...

With the Iowa caucuses finally behind us, the Presidential campaign of 2012 now begins in earnest, and will dominate our news and lives for the next year.   I predict we will hear words like "Obamacare," “Romneycare,” “government takeover,” and “individual mandate” (usually in sentences following the word “repeal”) until we can’t stand it anymore. If this is to be our fate in the New Year, then perhaps we can take some comfort in knowing that the debate probably won’t make a dime’s worth of difference about where most of us get our health care over the next few years or how we pay for it. This is because the 2010 Affordable Care Act and the individual mandate were not really health reform .   They were efforts to preserve health insurance as we know it, by getting more people who can afford it to purchase private insurance, and more who cannot onto the Medicaid public insurance program. So maybe we should take a minute between caucuses, primaries, and the general...

With the Iowa caucuses finally behind us, the Presidential campaign of 2012 now begins in earnest, and will dominate our news and lives for the next year.   I predict we will hear words like "Obamacare," “Romneycare,” “government takeover,” and “individual mandate” (usually in sentences following the word “repeal”) until we can’t stand it anymore. If this is to be our fate in the New Year, then perhaps we can take some comfort in knowing that the debate probably won’t make a dime’s worth of difference about where most of us get our health care over the next few years or how we pay for it. This is because the 2010 Affordable Care Act and the individual mandate were not really health reform .   They were efforts to preserve health insurance as we know it, by getting more people who can afford it to purchase private insurance, and more who cannot onto the Medicaid public insurance program. So maybe we should take a minute between caucuses, primaries, and the general...

Implementing health reform in the states is a governmental responsibility.   But Kaiser Health News reported this week that states are turning to foundations to help them with the costs of implementing these reforms.   Financing governmental duties has not traditionally been the role of a foundation.   Governmental programs should be implemented efficiently, but asking foundations to pay for this implementation is drawing dollars away from the most important work of foundations. This important work involves investing resources in promising initiatives that aren’t yet “government ready.”   Foundations are uniquely equipped to provide seed funding to experimental and innovative programs before they are ready for governmental action. On the other hand, funding governmental obligations leads to two unintended consequences.   First, it relieves governments of their obligation to justify to the public the expenditures they need to make to implement their prog...

Implementing health reform in the states is a governmental responsibility.   But Kaiser Health News reported this week that states are turning to foundations to help them with the costs of implementing these reforms.   Financing governmental duties has not traditionally been the role of a foundation.   Governmental programs should be implemented efficiently, but asking foundations to pay for this implementation is drawing dollars away from the most important work of foundations. This important work involves investing resources in promising initiatives that aren’t yet “government ready.”   Foundations are uniquely equipped to provide seed funding to experimental and innovative programs before they are ready for governmental action. On the other hand, funding governmental obligations leads to two unintended consequences.   First, it relieves governments of their obligation to justify to the public the expenditures they need to make to implement their prog...

Babies crawl before they walk.  c. Microsoft Office Image The Affordable Care Act (ACA) marks its first birthday this week.   It may not be off to a running start, but it isn’t exactly sitting still either.   The most debated provisions, like the individual mandate and the Medicaid expansions, are still three years in the future. In the first year, ACA’s biggest developmental milestones have affected older Americans, people with mental and physical disabilities, and consumers in general.   Which of these populations is making the most progress? Medicare recipients and early retirees have taken the most steps forward .     As of January 1 st , all Medicare Part B recipients are entitled to a free annual physical, with free cancer, cardiovascular, and skeletal screenings, and free flu shots.   150,000 beneficiaries had taken advantage of this through February 23 rd .   This number will grow, to many millions before the end of the year. Also, over ...

Babies crawl before they walk.  c. Microsoft Office Image The Affordable Care Act (ACA) marks its first birthday this week.   It may not be off to a running start, but it isn’t exactly sitting still either.   The most debated provisions, like the individual mandate and the Medicaid expansions, are still three years in the future. In the first year, ACA’s biggest developmental milestones have affected older Americans, people with mental and physical disabilities, and consumers in general.   Which of these populations is making the most progress? Medicare recipients and early retirees have taken the most steps forward .     As of January 1 st , all Medicare Part B recipients are entitled to a free annual physical, with free cancer, cardiovascular, and skeletal screenings, and free flu shots.   150,000 beneficiaries had taken advantage of this through February 23 rd .   This number will grow, to many millions before the end of the year. Also, over ...

Why is it so important that Florida has won a $35.7 million health reform act grant to participate in the federal “Money Follows the Person” program? A recent news story provides the answer.    It tells the story of a 20-something Florida resident who is a quadriplegic living in a nursing home.   He doesn’t want to live there.   But he doesn’t have a choice.   It’s the only option for which the Florida Medicaid program will pay.   We hope he’ll be alive for many years.   A back-of-the-envelope calculation suggests that the cost of his care could approach $4 million by the time he is 65. A December, 2009, AARP Long Term Care Brief showed that Florida spent 86% of its Medicaid long term care dollar on institution-based services.   It spent about half the national average on home and community-based services (HCBS). The “Money Follows the Person” program offers a low cost remedy.   Enacted in 2007, the program has already provided over $1.4 bi...

Why is it so important that Florida has won a $35.7 million health reform act grant to participate in the federal “Money Follows the Person” program? A recent news story provides the answer.    It tells the story of a 20-something Florida resident who is a quadriplegic living in a nursing home.   He doesn’t want to live there.   But he doesn’t have a choice.   It’s the only option for which the Florida Medicaid program will pay.   We hope he’ll be alive for many years.   A back-of-the-envelope calculation suggests that the cost of his care could approach $4 million by the time he is 65. A December, 2009, AARP Long Term Care Brief showed that Florida spent 86% of its Medicaid long term care dollar on institution-based services.   It spent about half the national average on home and community-based services (HCBS). The “Money Follows the Person” program offers a low cost remedy.   Enacted in 2007, the program has already provided over $1.4 bi...