Medicaid is helpful and should be protected

Put the bat away

By Barb Rea
ESPC health policy volunteer

Advocates and providers who work with low income seniors and families and individuals with disabilities should be aware of what went on at the Wyoming Legislature’s Join t Labor, Health and Social Services Committee meeting May 9-10in Evanston.
I am concerned about the ongoing attacks on Medicaid and the Affordable Care Act and the misguided belief that we can reform health care without the aid of a strong federal partner.
On the bright side, new committee members are getting intensive education from experts on health care and health reform.
Other aspects of the committee’s work were not so bright. Committee Co-Chairman Sen. Charles Scott, R-Casper, felt the need to add his personal interpretation to almost every piece of information presented. He painted Medicaid as a perennial problem in the state, and assured the committee that the new federal health care law, which he dismissively terms “Obamacare,” will be repealed or at least defunded. He also continues to portray his pet project, Healthy Frontiers, as a viable program which could be used to replace both Medicaid and the benefits offered in the new legislation.
The truth is that Medicaid is an efficient way to provide health care to many low income, elderly, blind and disabled individuals in Wyoming. Like the promise we made to the elderly with Medicare, Medicaid is the promise we made as a nation to provide healthcare to the poor, disabled, blind and elderly. Individuals who qualify for this program are guaranteed the right to comprehensive healthcare.
We learned from the experts testifying at the meeting that the federal taxes we pay in Wyoming are essentially subsidizing low-income care in other states. Wyoming’s Medicaid program has always provided bare minimum services to the fewest people possible under federal law. Other states use the program to leverage more federal dollars into their healthcare systems and provide more health care for people who would otherwise depend on emergency rooms when they are ill or injured.
Our state leadership seems intent on making sure we provide fewer services and use more state money to do it, just to send a message to Washington that we can do this ourselves.
Senator Scott used every opportunity to imply, incorrectly, that Medicaid enrollees tend to overuse the system and are always trying to game the system to get more than their fair share—making Medicaid more expensive than private coverage. At one point he digressed at some length about rules which would hypothetically allow mothers to quit their jobs so their children can qualify for Medicaid. Then, Scott said, the mothers are able to go get their jobs back and their children go right on receiving health care, “and there is nothing we can do about it.”
Scott’s attitude was bolstered by the state’s new Director of the Department of Family Services, Steve Corsi, who made a stunning assertion that 30% to 40% of people who enroll in Medicaid in Wyoming, come dressed like he was (black suit and new haircut) and driving an Escalade, “and there is nothing we can do about it.”
Senator Scott let the committee’s disgust percolate until Wyoming’s Medicaid Director, Teri Green, was able to question the validity of Mr. Corsi’s numbers. Mr. Corsi later apologized for using an inflammatory example and a “guesstimate.”
Later we learned from another presenter, that nationally less than 10% of Medicaid payments are claimed fraudulently, and in Wyoming the figure is less than 6%. Moreover, research tells us most of the fraud by far (80%) is committed by providers (primarily medical-device and pharmaceutical companies). Less than 10% of the fraud is committed by patients. Click here to read Health Insurance Fraud: An Overview
National research verifies that Medicaid is far less expensive than private coverage, but Sen. Scott continues to cite numbers to the contrary, numbers that have never been publicly vetted and do not seem logical to the people who manage Medicaid. (See below for links to this research)
Rather than persistently portraying Medicaid as a problem, the committee should be looking at Medicaid as a key component to stabilizing the entire health care system. It will help ensure that everyone has insurance coverage. Complete coverage, in turn, is part of the solution to stabilizing the market by eliminating the cost shifting that occurs when the uninsured seek and receive emergency care.
Under the Affordable Care Act, Medicaid eligibility will be simplified and expanded so that it covers all low-income people who earn up to 133% of federal poverty level ($1207/month). The state will be responsible for part of the cost of care for about 6,000 Wyoming individuals who are currently eligible for Medicaid but have not applied. These people are probably not enrolled because they are healthy, so they are not expected to add a huge burden to the state budget. The expansion of the program to finally include all low-income adults will be almost entirely paid for by the federal government (100% till 2017 and dropping to 90% in 2020).
Does it really make sense to opt out so our tax dollars can go to other states?
Don’t we want our poor citizens and blind neighbors to have access to the healthcare they need when they need it?
If Medicaid were privatized, as Senator Scott seems to be advocating, those federal matching dollars would disappear, and the costs would be shifted to state and county budgets or to those who pay premiums for private insurance. We would be paying both federal taxes that don’t come back to Wyoming and higher premiums.
If we want to accept the federal match available under the Affordable Care Act, we will have to guarantee that we will provide a program in Wyoming that will be at least as strong as the Affordable Care Act. We will have to pass a law that provides comprehensive coverage to all our citizens. Would we be able to achieve this with a private insurance industry that has been pushing poor and sick people off their roles systematically for decades? This practice is the reason we had to develop Medicaid and Medicare in the first place. We need those public programs to make our system work, and we need them now more than ever.
If we want our Medicaid program to run more efficiently, we should just ask Tom Forslund, our new, capable Director of the Health Department, to make it so, not try to reinvent the wheel. Medicaid will be a big part of our state budget because it serves an important function for our friends and neighbors who need healthcare and for those who provide healthcare services. We should prepare for the larger numbers it will cover instead of pretending poor people’s healthcare needs can be legislated away.

Links to Medicaid vs. private insurance research
“Trends and Indicators in the Changing Health Care Market Place: Medicaid Payment per Enrollee by Acute and Long-Term Care, 2003 http://www.kff.org/insurance/7031/ti2004-1-15.cfm

“Trends and Indicators in the Changing Health Care Marketplace: National Prescription Drug Expenditures, Percent by Type of Payer, 1994-2004” Kaiser Family Foundation http://www.kff.org/insurance/7031/ti2004-1-16.cfm

“Comparison of Expenditures in Nongroup and Employer-Sponsored Insurance” Kaiser Family Foundation http://www.kff.org/insurance/snapshot/chcm111006oth.cfm

“MEPS Topics: Health Care Costs/Expenditures” Agency for Healthcare Research and Quality http://www.meps.ahrq.gov/mepsweb/data_stats/MEPS_topics.jsp?topicid=5Z-1

“Comparing Public and Private Health Insurance for Children” Center on Budget and Policy Priorities http://www.cbpp.org/files/5-11-07health.pdf

“Medicaid, Private Health Insurance and the Uninsured” John Holahan, The Urban Institute http://aspe.hhs.gov/medicaid/jan/Holahan.pdf

“Expanding Medicaid a Less Costly Way to cover More Low-Income Uninsured Than Expanding Private Insurance” Center on Budget and Policy Priorities http://www.cbpp.org/cms/index.cfm?fa=view&id=429

“Administrative costs on Health Plans: A systematic review of current studies” Deloitte Center for Health Solutions http://www.deloitte.com/view/en_US/us/Industries/health-plans/1fdbe665e4e06210VgnVCM200000bb42f00aRCRD.htm


Editor's note: Barb Rea is an ESPC volunteer and represents the organization in the coalition Consumer Advocates: Project Healthcare.

Equality in the Equality State

House may not bring up anti-equality amendment
Medicaid studies backed by House Labor, Health committee

By Sarah Gorin
ESPC researcher and lobbyist

The House leadership reportedly is considering the option of not bringing up SJ5 - Defense of marriage – constitutional amendment, for debate. SJ 5 proposes amending the Wyoming Constitution to say that only a marriage between a man and a woman is valid or recognized in Wyoming.

A proposed constitutional amendment requires a two-thirds vote, and apparently proponents do not have close to the 40 votes required to get the measure through the 60-member House. A debate will take hours, hours that will kill other bills waiting to be heard, and could well be futile if the votes are not there.

There are reports that the House leadership also does not want to add to the state’s fame on national television:

YouTube - Rachel Maddow- Wyoming anti-abortion bill advances

The House already has approved HB 74 – Validity of marriage, which recognizes marriage as a contract only between a male person and a female person, and not involving more than two parties. The bill also prohibits recognition of marriages or civil unions contracted in another state, if the relationship does not meet the above criteria.

HB 74 is awaiting debate in the Senate. We encourage readers to contact their Senators. Send a gentle, polite email message outlining your reasons for opposing the bill. The legislature’s Hotline enables you to leave a message asking your senator to vote no on HB 74. Be sure to leave your name and a telephone number for the senator to call you back should he or she be so inclined.

Health care still chronically ill …

ON Friday, the House Labor, Health and Social Services Committee heard and approved two bills relating to the Medicaid expansion contemplated by the federal Affordable Care Act (ACA).

Medicaid currently provides health care coverage for people in four categories, all low-income: the aged, blind and disabled; children; pregnant women; and caretaker adults. Under the ACA, Medicaid will be expanded to include everyone with incomes under 133% of the federal poverty level.

Those who already have insurance will be able to keep it. Everyone else with incomes above 133% of poverty will have the opportunity to purchase private health care coverage under state health insurance exchanges, which are supposed to provide transparency for the consumer. The federal government will provide subsidies to help pay premiums to those with incomes up to 400% of the federal poverty level.

The two bills considered and approved by the committee today look at two different aspects of the Medicaid expansion. SF 50 - Medicaid options study, will examine alternatives to Medicaid – e.g., can it be provided more cheaply in a different format?

SF 102 - Medicaid cost study, will look at the costs of the Medicaid expansion in its current form.

The committee discussion revealed a great deal of misinformation about the ACA, along with a fair amount of hostility. This seems to be spawned, at least in part, by frustration with the current Medicaid program, where costs continue to rise just like other health care costs.

The dense interconnectedness of health care costs will require some sustained attention from legislators. For example, Medicaid is undeniably a substantial source of funding to our state’s health institutions, nursing homes, county hospitals, pharmacies, and private medical providers.

While this is not justification for simply throwing money at all these entities, any significant reduction in Medicaid spending will adversely affect them and consequently the availability of medical care to Wyoming residents.

The Equality State Policy Center is a member of Consumer Advocates: Project Healthcare (CAPH), which is working to educate the public and decision-makers about the ACA and other health care proposals from the consumers’ point of view.

On February 22, CAPH will host an informational meeting for any and all interested parties about the new federal insurance pool for people with pre-existing conditions who have not been able to obtain coverage. Premiums for the Pre-existing Conditions Insurance Pool (PCIP) are significantly less than those for the state’s high-risk pool.

The meeting will be held from 1:30 p.m. to 3:30 p.m. at the Laramie County Public Library in Cheyenne.

Participate
Citizens can register their opinions on specific legislation by using the “Online Hotline” or the telephone Hotline – 1-866-966-8683 or, in Cheyenne, 777-8683.

Extended unemployment benefits? Not in Wyoming

Out of work? Too bad, pal

House flushes $38 million in federal funds, turns back on Wyoming unemployed

Wyomingites who lost their jobs in the Great Recession were told by a majority of Wyoming House members today to find work. The House rejected House Bill 244 – Unemployment insurance amendments on a 25-34 vote.

The House majority sent this message despite seven straight quarters of decline in new business formation in Wyoming. Moreover, from June 2008 to June 2010, Wyoming lost 15,200 jobs, according to Wyoming Department of Employment statistics.

The defeat of HB 244 means Wyoming will not see close to $38 million in available federal funds circulate through our economy. Instead, workers who fall into poverty when their benefits run out will be forced to turn to programs such as Medicaid and food stamps to take care of their families – programs whose growth disturbs many of the same legislators who voted against HB 244.

The bill would have brought about $24 million in extended unemployment insurance benefits for 13 weeks to workers who exhaust their ordinary unemployment benefits between March 15, 2011 and Jan. 1, 2012. Sponsor Rep. Cathy Connolly (D-HD13, Laramie) said the measure, funded fully by the federal government following Congress’ December decision to again fund extended benefits, would help 7,500 workers survive the recession after losing their jobs through no fault of their own.

Take a look at the arithmetic: $24 million divided by 7,500 workers divided by 13 weeks of extended benefits means the average check for a worker getting these benefits would be less than $250 per week, hardly a gravy train. It’s difficult to provide food and housing for a single person on that income; supporting a family of four would not be possible in Wyoming.

The bill also would have changed state unemployment insurance law to enable the state to tap another $14.2 million in American Restoration and Recovery Act funds. About $5 million of that money would have financed the expansion of the base period used to calculate eligibility for the insurance. More workers would have been eligible.

Another $9.2 million would have been available to pay for benefits to unemployed workers who enrolled in state-approved training programs that would give them the skills needed to move into other occupations where the state has projected jobs will be available in the future.

A legislator who owns a coffee shop admitted she formerly was a critic of people receiving unemployment benefits, but she now gets 100 applicants when she advertises a single position, showing that there are a lot of people out there looking for work.

But the argument that the program is “a hand up, not a hand out” for people who want to work carried no weight.

Instead, the House resounded with tales of fraud and little sympathy for the unemployed, saying that unemployment benefits reduce the incentive to look for work.

Private contractors and construction union lobbyists joined forces to advocate for the bill as a way to address unemployment in the construction sector, which is hovering near 20%, but to no avail.

Here’s the roll call vote in today’s House vote on HB 244. Take a close look:

Ayes: Representative(s) Barbuto, Berger, Blake, Blikre, Botten, Burkhart, Byrd, Campbell, Connolly, Craft, Esquibel, K., Freeman, Goggles, Greear, Greene, Harshman, Krone, McOmie, Patton, Petroff, Roscoe, Steward, Throne, Vranish and Zwonitzer, Dn..

Nays: Representative(s) Bonner, Brechtel, Brown, Buchanan, Cannady, Childers, Davison, Edmonds, Eklund, Gay, Gingery, Harvey, Hunt, Illoway, Jaggi, Kasperik, Kroeker, Lockhart, Loucks, Lubnau, Madden, McKim, Miller, Moniz, Nicholas B, Peasley, Pederson, Petersen, Quarberg, Semlek, Stubson, Teeters, Wallis and Zwonitzer, Dv..

Excused: Representative(s) Shepperson
Ayes 25 Nays 34 Excused 1 Absent 0 Conflicts 0

Loud and proud in the halls of power

MLK Day brings ebullient crowd into Capitol

Martin Luther King Day demonstrators celebrated King’s annual holiday with a march from the old Union Pacific Depot to the Capitol, loudly, brashly reminding everyone of that American revolutionary’s commitment to equality and his drive to free all of us from the oppression of racism.

It was obvious the crowd also was energized by the impending inauguration of Barack Obama as the country’s 44th president and the first black man to hold that office. Whoops and shouts accompanied every mention of Obama’s name until one speaker silenced them with a lame joke that Obama should not have been elected.

He recovered but the humor did not go over very well.

Still, with all this going on, one wonders why the legislature continues to work tomorrow at 10 a.m., the approximate moment that Obama will have his hand on a Bible swearing the oath of office. Any presidential inauguration is a great civic moment. We all should stop and take notice. Even our hard-working legislators deserve a pause.

Campaign finance in Senate

Meeting in Committee of the Whole Monday, the Senate gave its initial approval to SF-12, a measure that will raise campaign contribution limits in Wyoming races to $2,300 per individual per election. Lead sponsor Sen. Bruce Burns of Sheridan told his colleagues that the limits have not been raised since first imposed in the 1970s.

He also said he finds problematic that fact that federal law allows him to contribute $2,300 per election to a candidate for Congress but state law limits him to a contribution of just $1,000 to a candidate for statewide office such as governor or state auditor.

But the good senator's first argument assumes that the legislature picked exactly the right limit 30 years ago. We believe $1,000 was too high then and just about right now, particularly for a legislative race. It just does not cost that much to run in Wyoming.

And for argument 2, why not impose tiers that establish higher limits for statewide races and maintain the current limits for legislative races? Higher limits will crowd voters out of campaigns in favor of people with money to pass around.

The House takes up campaign finance Tuesday when its Corporations Committee considers HB-117, a measure proposed by Rep. Mary Throne of Cheyenne. It will limit contributions from Political Action Committees to $1,000 per candidate per election. The committee meets when the House recesses for lunch.

Medicaid shortfall seen

Department of Health officials told the Joint Appropriations Committee Monday that demand for Medicaid services is climbing in the recession as low-income workers lose their jobs. With the loss of income, they meet the state's very tight Medicaid qualification rules. The department now expects a $33.2 million shortfall. They agreed with Senate Chairman Phil Nicholas of Laramie that other services the department is required by law to deliver and funds needed for Development Disabilities waivers mean the department may be short $49 million.

Legislators will have to scramble to find funds for those programs and others pushed in new legislation, including proposed increases in mental health services.

Jennings explains missed hearing

Sen. Kit Jennings of Casper spotted me in the Senate lobby Monday and chastised me for claims in Monday’s posting that he missed a hearing of one of his own bills last week. Jennings said he had made arrangements to be called from a separate meeting when his bill, SF53 – Property tax deferral, came up in the Senate Revenue Committee. The bill came up but no one notified him, he said.

Jennings said I could have learned that simply by talking to him. He’s right. I apologize for the comment and the failure to follow through. The committee, meanwhile, has re-scheduled the hearing of the bill Tuesday when it meets over the noon recess.