So you’re an audio/visual learner. Maybe you prefer to watch Aaron Carroll talk about Medicaid block grants on Healthcare Triage. Five minutes to being smart enough to policy wrestle any date in the D.C. metro area this week. THERE WILL BE A QUIZ.
1.) What are some of the “perverse incentives” created by Medicaid’s current funding model? (HINT: think fee-for-service care). Does block granting address these incentives? Include direct and indirect implications for state budgets.
2.) If per-person spending has remained relatively flat, and Dr. Carroll is correct in saying that the increase in overall Medicaid spending comes from the increased number of enrollees, and enrollment eligibility is tied to the federal poverty level (as well as qualifying criteria such as being a child, a pregnant woman, or disabled) what can we assume about poverty in America? HINT: I really pointed you right at this one. You don’t need a hint.
Now go out there and get’em.
There’s no magic in how Congress reduces spending under a block grant mechanism. It just says it will do so, and leaves the hard decisions to others. It’s possible that some states will come up with solutions we haven’t been able to see before, and find a way to reduce spending without causing problems. If they can’t, though, they will have to make do with less, make the hard choices and face the brunt of the blame.
This column is A++. Apparently, block grants are simple: states are given a set amount of money to sustain their Medicaid population. If their needs exceed that amount the state has to come up with the difference or make cuts: recipients, services, costs covered. States that rely on a higher percentage of federal dollars for Medicaid are more likely to come up short in this equation. Many of these states have things in common. They are poorer, health disparities greater, outcomes worse. The fear is that these states, already behind, will slip further if a gap in funding grew. It disconcerts me greatly that Americans are resigned to the great divides that exist among us in health measures and life expectancy. Block grants forewarn of further disengagement of rich from the poor, North from the South, urban from rural, one race from another. Our federal government and it’s protective policies and programs unite us, remind us that we are in fact one nation, interdependent.
Sometimes I pledge allegiance to bureaucracy. When nothing else will hold us equal, it comes in with it’s maddening and obstinate rules. It does.
How Obamacare Lowers Your Property Taxes – Forbes.
A snapshot of this trend can be seen in Cook County, Illinois, where the public hospital system has seen a decrease in patients who cannot pay their bills thanks to the law’s expanded Medicaid health insurance for poor Americans.
Long and short–Medicaid expansion offers insurance to people in poverty, which is a means to provide payment to public hospitals and health systems that are mandated to give care regardless of an individual’s ability to pay.
Here’s the AHA reports on uncompensated care through 2012 for those who want numbers (before Medicaid/marketplace).
PS- I love working for a public health system because it is the closest thing I’ve seen to fulfillment of that phrase under Lady Liberty’s feet. That’s corny as hell, right?
RAM is well know within the VA healthcare community. Clinics are held in tents, trailers, and the Wise County Fairgrounds’ livestock stalls. Lines are legendary. People sleep in cars and on the open ground for days to get a chance to have teeth pulled, rudimentary diagnostics, and the scant amount of education and management of chronic conditions that time allows. Efforts by medical and dental staff are herculean and all volunteer. Patients are nearly all uninsured (which does not at all mean they are not working if you must ask).
This is an access issue, people! RAM was developed to provide care to remote villages in South America. Over 60% of RAM clinics are now in the US. It is the primary source of healthcare for thousands of people in Southwest. WaPo did some great reporting on it this year, and now we’ve got an independent film coming out.
The WaPo article is titled Misery that Shouldn’t Exist. Cough Medicaid expansion cough cough. More to come on the politics, the policy, the people.
The struggle is real.