Tag: Health care for the poor
I’m going to take a little “time out” from my analysis of the American Health Care Act to rant a bit. What about? The sheer cluelessness of many of the people who report on the Obamacare repeal and replacement plan as well as those who are interviewed about it.
Many reporters (and Obamacare proponents) keep coming back to beat the same old dead horse – the subject of how many people will “lose” coverage. I have some questions and comments regarding these claims, and the first question is:
What coverage will they be losing?
If it is expanded Medicaid coverage and these are able-bodied people, I am not entirely sure it is the role of the federal government to make sure they stay healthy. Isn’t it their responsibility?
As a disclaimer, in past posts on this blog, I have praised Indiana’s Medicaid expansion program because, since that state believes it must do something, at least it has chosen a free market model to utilize, rather than the traditional complete government dependency model, ensuring that the working or temporarily unemployed poor have a health care safety net while being encouraged to move away from it. There are actually mechanisms in the Healthy Indiana 2.0 plan intended to enable beneficiaries to move from the Medicaid plan to commercial insurance. I hope that the people receiving a benefit from that plan will use that program as a temporary safety net, and not as a hammock.
However, the trouble is – too many people get used to government assistance and they become government-dependent, and that is why there are so many people screaming about the fear of losing “coverage.”
I came across a quote today that really “nailed” this government-dependency phenomenon in an editorial written in a local online news publication. The writer Brian Hyde says this:
“And let’s not forget about the disservice of creating dependency upon a system that can only thrive when those it purports to save are kept powerless. Politicians love to create classes of victims which they then pretend to save.”
This quote really goes to the heart of the Democrats’ attitude when it comes to keeping the same old health care and general welfare system that has not really done much good, but has managed to keep specific classes of people in its stranglehold of generational poverty and dependency.
Another group of people who are getting worked up about the possible repeal and replacement of Obamacare are those who receive generous subsidies at the taxpayers’ expense to buy insurance from the Obamacare exchanges. With some shame, I must admit I am one of those people buying a health insurance policy on the exchange and receiving subsidies, only it was not MY CHOICE, so I would be very happy if Obamacare went away.
How did that happen?
Neither my husband nor I get employer-paid insurance at this time. However, my husband has Type II Diabetes, and although he does a good job at keeping his blood sugar in check, he felt the need for some kind of “coverage” just in case something went terribly wrong with the diabetes. At this time, but hopefully not for too much longer, we are what one would call lower middle class, so we qualify for a subsidy.
I had originally told my husband that I did not want to be involved in getting the Obamacare at all, and would just take my chances and skip it (with about a billion good reasons why). Of course, I totally understood where my husband was coming from, but that didn’t mean I had to get that awful insurance (or so I thought). Well, guess what! I learned that when household income is considered for receiving Obamacare subsidies, it means I am required to be covered along with my husband on the same plan.
Talk about sexism!
Didn’t President Barack Obama and all his flunkies always rant about a “war on women?” Of course, that line was always pushed to create the narrative that any insurance women were covered by, even if it was a group insurance for a Christian company or other group like Little Sisters of the Poor, had to pay for birth control, even if it was an abortifacient. Refusing to provide that kind of coverage was the left’s idea of a war on women. God forbid they should take their birth control prescription to Walmart or similar discount store and get a good cash price for it.
Yet it’s not a “war on women” to FORCE a woman to be covered by the same Obamacare insurance as her husband whether she wants to or not? Those leftists scream about a woman’s right to the CHOICE of getting an abortion, but according to them, she does not have the right to CHOOSE whether she wants to be on the same Obamacare plan as her husband, which is very convenient hypocrisy.
Actually, my husband acknowledges that the Obamacare plan we have stinks; it has the typical very high deductible and it’s the only carrier in our area, which is basically a monopoly.
The trouble is that, as one doctor pointed out, the old type of catastrophic plans are illegal under Obamacare because they don’t have all the bells and whistles. I think my husband and I would both be better served being able to buy a very basic catastrophic plan and getting a health savings account to go with it. We would probably have to resort to some kind of high risk pool because of the diabetes issue (if that will be part of the repeal plan), but at least we could skip other forms of coverage currently demanded by Obamacare.
The important thing is that if Congress does the repeal plan right, we can hope for all kinds of choices in health care coverage and access. That part about Congress doing the repeal right is a big IF because there are so many issues about the real cost drivers of health/medical care not being considered in the repeal and replacement process, at least not as far as I can tell.
A Rebel at Heart
In a future post, I will have to tell you about my outright refusal to use my “coverage” to get the two maintenance prescriptions I use, and the great results that come from that.
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I featured a different approach to caring for the poor two posts ago. That approach is in full gear with the Healthy Indiana Plan 2.0, which I described in that former post. The HIP 2.0 plan is using the basic approach touted by many free market advocates in providing a monetary account of $2,500 (that would imitate a market Health Savings Account) to each beneficiary and a High Deductible Health Plan, which is an “insurance plan” to cover medical expenses if the monetary account is exhausted.
When I read articles about different issues in health care, I generally make a point of reading people’s comments about the article to see how those ideas are being received. I did that in the case of the article entitled “Healthy Indiana 2.0 is Challenging Medicaid Norms” by Seema Verma and Brian Neale in Health Affairs Blog, which is the article I based my post on.
Sometimes the comments I read are supportive, sometimes they raise questions about the topic, and sometimes they are clearly just meant to tear down an idea with or without reason.
I am going to take a few of those questions or criticisms I found in the comments section and analyze or answer them.
What About the Most Vulnerable People?
One doctor asked what protections are in place for the most vulnerable people in Indiana – the disabled, the blind and the aged?
I agree that the article was geared toward what is being done to assist in making sure able-bodied but low-income Indiana residents have a way to tend to their health care needs, and did not address the more needy people. I wanted to answer this question in my mind as well, so I called the Medicaid service line for HIP and spoke to a representative who told me that the disabled, blind and elderly people who are not covered by Medicare are taken care of by Hoosier Care Connect, which is a group of managed care plans from which these Medicaid beneficiaries can choose.
There is also a program that provides assistance to disabled people who are employed, ensuring that they have access to Medicaid coverage and are not penalized for working additional hours, or even getting a raise. Even though I am not a big fan of too much government intervention, I do feel that it is probably appropriate to protect disabled employed people who, I am sure, have more than the average challenges in life and could be at risk of “falling through the cracks.”
So that answers the question regarding the provision of care for vulnerable “populations.” However, I hate to use the term “population” in connection with people and health care because everyone is an individual with their own needs, issues and challenges.
Encouraging Health Care Consumerism Among the Poor
Someone else who commented brought up the issue that HIP 2.0 beneficiaries are informed, through a monthly statement, about the cost of medical care they received with the intention of teaching them to be better health care consumers. Her contention was that the effort to encourage beneficiaries to be better health care consumers was toothless unless they could find out costs before receiving care.
I have two responses to this issue.
*First of all, maybe if HIP beneficiaries look at a bill detailing how they have spent their health care dollars, they could make a learning experience out of trying to find less expensive (but still high quality) care elsewhere. The comment that most people find it very difficult to find out costs for care ahead of time can be true, although this is most often true of hospitals.
With the use of their $2,500 monetary account, these beneficiaries might seek out a physician who does Direct Primary Care. Although Direct Primary Care physicians generally operate “third-party free” which means they do not take Medicare, Medicaid or even commercial insurance, it seems that if the Medicaid beneficiary is using their POWER account to pay for their care directly, the DPC option could work well for them, and even prolong the availability of those funds during the year.
*The other issue, in terms of most people finding it difficult to find out costs for care ahead of time, is something that needs to change throughout the country. It’s high time that we all started demanding transparent pricing. If surgical facilities such as Cedar Orthopaedic Surgery Center in Cedar City, Utah or Surgery Center of Oklahoma in Oklahoma City, along with many other surgery centers and Direct Primary Care physicians that are riding this wave, can do this, hospitals will eventually find that they must do this too if they expect to keep getting patients for elective procedures.
Out With the Old…In With the New!
Yes, every new, out-of-the-box concept may have its wrinkles, questions to answer, and improvements to be made, but it’s time to veer away from the same old way of providing charity care that seems to only dig a deeper and deeper hole in government spending with questionable results.
If you are interested in delving deeper and reading the article I referred to, here is the link. Feel free to let me know what you think about this by commenting on my blog. Also, look for my email subscription service at the upper right hand corner of this post so I can update you on new posts in my blog and future offers.
We have all heard the doomsday laments of the left claiming that “health care” will be ripped away from the sick and the poor as well as the elderly. The premise of the left side of the political spectrum is that Republicans are heartless creatures who just want to throw sick and/or poor people out onto the streets to die in the gutter.
As a conservative Christian woman, I can tell you that is totally untrue! In fact, I have a strong desire to see everyone – from the poor to the rich (because we are all human and vulnerable) – taken care of if they have medical issues.
How Do We Make Government Care for the Poor Work?
Medicaid is the government program designed to care for the medical needs of low-income people.
I discussed, in my previous post, how unsustainable the Medicaid system has become, especially because it has been expanded in many states since Obamacare became law, with several states experiencing cost overruns because the number of enrollees has outstripped projections in those states.
However, one state stands out as a model for providing health care support for the poor that is light on government intervention and provides Medicaid recipients with choices – Indiana.
One of the problems with Medicaid has been that reimbursements to doctors for patient care have been so low that they do not even cover those doctors’ costs in keeping their practices open if they are running independent practices, so they either have to limit the number of Medicaid patients they treat or they have to totally opt-out of taking those patients. So those patients may have a card to show they have Medicaid coverage, but they do not have the access to primary care physicians that they need to stay out of emergency rooms if their illnesses progress too far.
Some people would like to blame “greedy doctors,” but how is a doctor supposed to remain in practice to treat anybody if they cannot even so much as cover the cost of treating individual patients?
How can that problem be solved while taking care of the medical needs of the poor? Enter Healthy Indiana 2.0, the Medicaid program for able-bodied adults living at or near the poverty level. According to a Health Affairs Blog article entitled “Healthy Indiana is Challenging Medicaid Norms,” by Seema Verma and Brian Neale, the state of Indiana launched this newest version of the Healthy Indiana Plan (HIP) in 2015 thanks to waivers approved by the federal government.
One of the most interesting aspects of Healthy Indiana 2.0, according to this article, is that it gives able-bodied Medicaid beneficiaries the opportunity to be prudent health care consumers. These beneficiaries receive a High Deductible Health Plan (HDHP) with a $2,500 deductible, which is paired with a “POWER” account of $2,500 that is very similar to the traditional Health Savings Account. Beneficiaries in this plan use the POWER account to pay for standard medical expenses up to the point that they meet the deductible for their health plan. At that point, the health plan will kick in to pay the rest of the medical expenses for that beneficiary.
Additionally, Healthy Indiana 2.0 pays for preventive services so the money for those services does not come out of the beneficiaries’ POWER account for the deductible, and they are incentivized to make proactive health choices.
Beneficiaries in these POWER accounts are also required to pay two percent of their incomes into these accounts to be used as available cash for medical expenses.
According to the Health Affairs Blog article, the incentives and consequences outlined in Healthy Indiana 2.0 are designed to “support transition” to a commercial or employer-sponsored insurance plan.
Then, according to Martina (last name not given) at Indiana’s Medicaid phone line, Indiana still enrolls elderly, blind, and disabled people in a managed care plan called Hoosier Connect Care. So the most vulnerable people are still taken care of.
I have little bit more to say about this plan, but that is for another day. However, I leave you with this thought today – that with the unsustainability of the current Medicaid system, our leaders need to be thinking “out-of-the-box” and be prepared to really innovate.
I am very frustrated by the outright lies the Democrats are trying to spread about the impending repeal of the Patient Protection and Affordable Care Act of 2010. Actually, the name “Affordable Care Act” is a misnomer. To most people who know better, the “reform” law, with its 2,500+ pages of economy-strangling regulations is more accurately known as the “Unaffordable Care Act.” I’ve seen this moniker cited by several people whose Facebook and Twitter pages I frequent.
Let’s Get Real
The Democrats’ new slogan about the likely repeal and replacement of Obamacare is “Trump wants to make America sick again.” Apparently Senate Minority Leader Charles Schumer (D-NY) and House Minority Leader Nancy Pelosi (D-Calif) engaged in a strategy session with President Barack Obama in the first week of the year.
According to a Jan. 4 article by the Washington Post, “Democrats: Trump Will Make America Sick Again,” a memo that came out of this strategy session partially reads as follows.
“Instead of fulfilling their promise to repeal and replace the Affordable Care Act, Republicans are going to make America sick again by offering no health care plan to the American people and actually dismantling Medicare, Medicaid, as well as the ACA.”
Although I will get back to the lie about the lack of a replacement health care plan, I am going to discuss the Democrats’ clinging protection of a crumbling Medicare and Medicaid system.
Let’s actually start with Medicaid, which is basically health care coverage for people with low-incomes. The scary truth is that states that are attempting to expand Medicaid under the rules of the ACA are finding that they face huge cost overruns.
For example, Arkansas is one of the states participating in Medicaid expansion, according to an Oct. 5, 2016 article entitled “Rising Cost of Medicaid Expansion Is Unnerving Some States,” written by Christina A. Cassidy on the Associated Press website. The article states that Arkansas has received 307,000 signups for the Medicaid expansion, which exceeds the projected 250,000. So the state is asking the federal government, which has been providing 100 percent of the costs for the expansion, for permission to charge some Medicaid recipients a premium for their coverage.
The same article states that Kentucky, another expansion state, has enrolled approximately 400,000 residents in Medicaid under the expansion. That state has budgeted $257 million for the fiscal years of 2017 and 2018, which far exceeds the original estimate of $107 million.
Creativity At Work
These are only a couple of examples of the budgetary havoc experienced by states that have expanded Medicaid based on the same old way of providing government coverage. However, there are bright spots of innovation that have the potential to actually provide needed health care for low-income people without busting a state’s budget or further inflating the national debt.
One of these bright spots include Healthy Indiana 2.0 (the latest version of the Healthy Indiana Plan), which utilizes Health Savings Accounts with contributions from the state as well as catastrophic insurance to cover for large medical expenses that cannot be anticipated. This program is already being used in Indiana. Another innovative proposal for covering the poor is being considered in New Jersey. This plan would incentivize physicians to work as volunteers in community clinics in exchange for state coverage for medical malpractice. This plan intends to provide primary care, and even psychiatric care, to low-income New Jersey residents at no cost to the residents, and has the potential to keep these residents healthy enough that the emergency room is very rarely needed.
Yes, there are great ideas out there for helping the poor receive health care, so any repeal of Obamacare does NOT mean that the poor would have the “rug pulled out from them.” I know that, as a conservative woman, I do not want to see anyone deprived of the medical treatment they need because of their inability to pay, but I feel that there are better ways of providing that care without increasing the national debt beyond sustainability or curtailing the free choices of American citizens because of “one-size-fits-all” government-controlled “health care.”
In the next few blogs, I will discuss some of these innovations at length.