Health Reform and the States

Deals are a part of legislation, a tradition in every Congress. Ahnold needs to understand that and stop caving to the Sarah Palin crowd.

http://www.political-buzz.com/

Of course, if we didn’t live in a day and age when people have been told for forty years that taxes are evil and Government is inherently inefficient then the States wouldn’t be facing these difficulties. They’d simply raise the proper amount of revenue to provide the service levels that their citizens rightly expect.

Paul, correct me if this is wrong, but my impression is that although the Federal taxation is pretty low – in historic terms – local taxes and penalties are actually quite high so that overall tax burden on any individual is actually higher than it would seem if one only looked at federal income tax.

I also get the impression that states hide behind the federal government knowing that any increase in taxation that benefits the states will by and large get blamed on the federal government.

Finally, an impression I have is that when it comes to inefficiencies in government a lot of the blame is due to the inefficiencies in State government, as opposed to federal government. Or is all this completely wrong headed?

“A political irony here, too, is that this bill sets up what could be a massive transfer of wealth from the Blue States to Red States.”

That’s not irony, that’s business as usual.
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http://www.nationalpriorities.org/publications/what_came_to_and_left_your_state_in_2005

More reasons why we should have a National Medicare for all.

The earliest this will happen is three years from now and no one knows what state the economy will be. The only reason I think the delay in starting sooner is to have some time to recover from this recession.

What Paul says.

Here in lies the problems:
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1. A Bigger Medicaid Tab

“Congress is looking to expand Medicaid because in terms of raw costs, it is the cheapest and most efficient way to cover people of modest means. That’s in part because Medicaid pays doctors and hospitals far lower reimbursements than private insurance does and in part because the states pick up some of the cost.”

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What this basically means is that those who do conform to the new eligibility guidelines contained in the bill, will find it very difficult to find a provider who will accept their “new” insurance. Thousands if not millions of people will have coverage, but they will not be able to find a Physician who will provide the necessary care. Already today, millions of Medicaid recipients find it not only difficult, but impossible in some areas to find a doctor who will accept their Medicaid insurance. This still leaves many people out in the cold so to speak and without care. They will however, continue to frequent the emergency rooms of our local hospitals for routine care, the most expensive of health care providers. Does this make any sense or cut costs?
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2. New Regulatory Burdens
Ms Tumulty and Ms Pickert are accurate in their explanation of the “burdens” the new regulations will create for many States. Suffice it to say that many of the States currently have various and different State regulations. Conforming to the new Federal regulations will not only be difficult, but require passage within each State, new regulations by the various State legislatures. As is pointed out in the article, the Federal Government could enforce the new national rules, but this would require creating a sizable new regulatory bureaucracy…but, do we and can we afford a new Federal Bureaucracy at this time when we are already over burdened with big government programs and agencies?
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3. Insurance Exchanges
This simply complicates the already overburdened State Insurance bureaus. The State Bureaus, who are now responsible for insurance regulations are not set up to handle the sales and marketing of new “exchange” insurance products. Many States will simply opt to pass legislation which will provide for regulations under the new “exchange” plans, but let private industry do all the groud work. This defeats the entire purpose of having an exchange in the first place. It does not create an atmosphere of competition among the various insurance companies offering a product. It will not provide for competition which would reduce costs, but create more insurance monopolies within the State. The larger insurance companies within any State will be the major player in the “exchange”. We will be dependent upon them and forced to hope they will make it affordable.
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4. A Fight for Federal Aid
This could have been summed up by calling it “Winners and Losers”. The “winners” are Nebraska and Lousiana. Both States receive unprecendented amounts of Federal Tax dollars to fund this new program. Other States are finding out quickly the burden for funding of this program will lie directly with them. State budgets for the most part across the nation are required to be budget neutral. Already in States like California, we see budgets which are not balanced, and other State programs are being cut. State employees are being laid off or fired. Look at it like a big pie. There is only so much of the pie that can be divided up, and this will cause either major tax increases on the State level for tax payers, or cuts to already existing State programs. Since we already know most States are very hesitant to cut programs, we shall see an increase in State taxes the tax payers of that State will be forced to pay.
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newfreedomblog.com

A lot of people probably don’t realize how good the Medicaid coverage is here in New York.

For New Yorkers, the health care crisis is most critical for the middle class. Of course Obama is busy throwing them under the bus with his push to partially fund the bill with a so-called “Cadillac” excise tax.

I agree. Not seeing the irony…

Except that the Senate was originally intended to prevent a tyranny by the most populous states. And now we have a tyranny by the least populous states. More of a historical irony.

How does the excise tax hurt the middle class? I thought it was only for policies over $23000 or something like that? How many middle class individuals have policies that cost that much?

BTW, KT, it would be nice if Swampland had more financial coverage. I understand if that isn’t the beat of the existing Swampland crew, but I feel like there has been a hole in the coverage of both the financial meltdown and the ostensible efforts of the WH, Congress, and the Fed to address the problems.

In particular, the departures of Dodd and Dorgan may have a significant impact on reform efforts.

Sqare 1: I think you make a point which is at the root of our troubles. Our health care and delivery system is so complicated that there are states where it is broadly available and states were it is less easily available. So the quiltwork is not very attractives.

One simply has to wonder how Americans tolerate such a shoddy delivery system that has been discredited time and time again. We debate how to deliver care to as many people as possible. Other democracies are focused on cost containtment and delivering services to 93% of their population..

We know what ails Washington; but we cling to political postures and drone on and on about choice, ackowledge that cost is a problem but do little at containment.

KT and Co can take the debate from the Feds to the States and down to the local authorities. We will pour out words. Nothing will be done, in the end. We are too wedded to isms.

It hurts the middle class in that many middle-class individuals, and union workers in particular, negotiated for and/or accepted positions based upon robust health care plans. These people took benefits in lieu of higher salaries. Now those benefits are being attacked and the workers are unlikely, in the short-to medium term, to see higher wages balancing out the negative repercussions from the excise tax (e.g. higher premiums, co-pays, etc.) that will be passed along.
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I am actually in favor of severing the employer-provided insurance model by removing insurance deductions. But, IMHO, you have to do it slowly so you don’t hose all the people who have acted in reliance on the current system.

Also, it is unfair to lump together as “Cadillac policies” the robust and comprehensive policies that unions may have negotiated for their members with the genuinely gold-plated policies that may be provided to senior corporate executives at a cost of $40-50k/year.

OK, I can see that but I thought that there were quite a lot of negotiated exceptions to the excise tax that affected a significant majority of union workers – at least at the transition stage.

Here’s another point which I was thinking about after hearing Obama speak on NPR about this. Part of the cost problem in the US is demonstrated by the fact that the US spends twice as much money on healthcare with the same results. Aren’t these types of policies emblematic of that?

Also, if the costs of the cadillac policies is unnecessarily high doesn’t retaining them also amount to “insurance industry bailouts” as many have complained the proposed bill is?

I’m genuinely asking not trying to be snarky – but it is an incredibly complicated area, it seems to me and not one in respect of which one can blithely talk about throwing people under the bus (which suggests that Obama/supporters of the excise tax think and know that it will amount to a tax on middle class but don’t care whereas it does seem to me that this might be a genuine point of disagreement)

One thing is for certain, when all is said and done, Obama, Pelosi and Reid will protect their base of support.
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Once the unions are done lobbying the hell out of Congress before this is put to a vote, you will see exemption after exemption for Union Workers. Those of us who are not union, will see our plans taxed as income, and the cost of our current policies will drastically increase.
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Just like the credits for Medicaid to the two major States, Nebraska and Lousiana will enjoy. Labor Unions will also get a pass.
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In the end the cost of health care reform in this bill will fall upon the small business man or woman to fund. Jobs will be lost. People will go unemployed, and new jobs will be put on hold. This all at a time when we can least afford it.

Rusty, you make it sound like the only special interests lobbying around reform are the unions – forget about pharma, insurance companies, chamber of commerce etc.

Are you saying that your current policy costs more than the threshold amount for cadillac policies?

KT:
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I’d like to add my support for sqr1′s request. This is not to say that health care or foreign policy is less important, it is to say that financial coverage would be greatly welcomed.

No homer, the Unions are the last of the big lobbyists to go after this so-called health care reform bill. Big Pharma already struck a “deal” with Obama in secret in the White House. Big Insurance got what they wanted in the “mandate to make everyone buy insurance”. All that is left is for Big Union to get their piece of the pie.
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As the final figure on how much will be taxed has not been determined, I am sure that any policy worth having will be taxed as income. Some will be taxed at their “Cadillac” plan. Another campaign promise broken by Obama. When McCain proposed taxing private insurance as income, Obama beat him over the head with it in the election. Just like the “transparency” deal, this too shall be another broken promise.

Excuse me, but do you think the purpose of this post was to provide you with substantive information? When I see these requests for more of the financial information I can’t help but chuckle. The sole purpose of this post is to anger the critters and get them to attack each other based on their ideologic red/blue state divisions. And before anyone attacks me for picking on KT just look at the post. What other purpose would there be to tell you to keep an eye out for tensions that have not naturally occurred? Was anyone focused on this before this post? She is trying to generate concern over taking from one to give to another, like she learned the lesson from the GOP who use these kind of divide and conquer tactics all the time when they say its going to go to illegal immigrants (i.e. mexicans) or people who don’t pay taxes (i.e. black people). Now we’re all supposed to up and arms because the red states run by leaders we hate are getting a better deal because of Senate shenanigans when she knows full well that the reason more funds are going to red states is because they have the highest percentage of uninsured. And of course she should have been able to easily connect that dot since the information came from one of her extensive articles about health care in texas. I notice there is no reference to that info but of course I could have missed it and in that case I will stand corrected. The bottom line is that the purpose of this site has become just as much a part of shaping the false narratives that we have been railing against. Get us all riled up over this issue and then msnbc will feel justified in saying the base is up in arms over this issue and then we are off to the races — another negative story about health care.

Dee,
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KT has been very good at keeping us informed as the health care reform bill makes its way through congress. Your statement that “The sole purpose of this post is to anger the critters and get them to attack each other based on their ideologic red/blue state divisions.” sounds like a paranoid delusion and I think is a bit unfair. Why waste your time reading/posting if this is how you feel? I for one appreciate all the fine work that KT has done.

Dee – and CP –

I think you both make, in part, the same point – that even the well-intended, thoughtful members of the press (I agree with CP that KT is one of those) do not seem to realize how much they add heat and not light to our political discourse. Covering policy as politics is amazingly destructive.

homer: one thing that i didn’t understand–until it was explained to me by someone at SEIU–is that these “cadillac” plans are pretty much a function of where you live, and you find these policies in some surprising areas. new hampshire, for instance, where there are very few hospitals–and therefore, where those hospitals have tremendous negotiating leverage to get really high reimbursements. andy stern of SEIU told me that they have city workers who earn only, say, $34,000 a year, but who still have these cadillac policies. he also says, for instance, that you are more likely to find them in upstate NY than in Manhattan. they did a study, and i’m trying to find the link. i will post it when I do.

square (and KT), I openly commented at one of the TIME biz blogs suggesting that the biz reporters team up / swap stories, etc. with the swamp reporters (and of course I had to drop KT’s and Amy’s names in high praise). I specifically mentioned biz topics with heavy political eyeshadow such as finance reform and unemployment, but HCR sure as hell applies too. Between both groups all angles can be covered. Then again, I doubt many here read my comments but maybe the reporters in both groups would be interested.

Homer:

Also, I should have pointed out, the Senate bill has higher limits for high-cost states, but only for three years.
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Here’s a Q&A that SEIU did for their members. This is not the study I was talking about, but it does have some facts about the tax in it. (I should note that I post this without supporting or opposing the tax itself.):
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http://www.seiu.org/2009/12/qa-on-the-senates-excise-tax-on-high-cost-so-called-cadillac-health-insurance.php

I’m not paranoid, I am critical. The reason I come here is to critique the media, I though that was the point, because its not as if I need someone to show me the news. We critique new narrative all the time yet KT always gets a pass and I believe its for the same reason that we have taken so many of the villagers to task. We accuse the villagers for selling out the truth for access, yet some of the commenters on this site do exactly the same thing and as long as KT maintains her cozy relationship with folks on the site she escapes the scrutiny given to every other journalist on this site. Of course, you don’t have to take my word for it do a search of her posts and scan them all at once and the glaring pattern will exonerate me and make it clear that she has been the one to agitate nearly every flame war on health care. She has had a consistently negative narrative about the legislation and she admitted that her chicken little attitude toward the legislation was the result of her own cynicism rather than anything specific. Every time we get close to passing something she injects dissent on this site and it in turn becomes fodder for the cable outlets who consistently use this site to inform their perspectives. Now while you don’t need to take my word for any of this, you ought to do the search before you call me paranoid. A literature review is what I am trained to do in order to unearth how the media narrative drives public opinion but unless you’re just sheep the least you ought to do is to check it out for yourself — or not and continue to get played.

Here is an interesting article, you may enjoy reading Karen and others.
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http://nursinglink.monster.com/news/articles/9285-lessons-of-a-weekend-of-free-health-care?utm_source=nlet&utm_content=nl_c1_20100107_freecare
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It is sad indeed that the richest nation on earth has to depend upon this type of health care intervention for people to get the health care they need.

I have been a doctor for 50 years. I am a just retired Prof of Medicine from UCLA. I have created a non-profit 501c3 corporation No More Medicines, Inc. We have a website, nomoremedicines.com. Our mission is to reveal and explain the reasons for skyrocketing healthcare costs, so that some sort of realistic corrective actions can be taken. When I started in Medicine there were few meds for high blood pressure and cholesterol, and type 2 diabetes was called “maturity onset diabetes” because we only saw it in patients >50 years old. The American diet and Big Pharma have changed all that. Baskin Robbins’s Large Heath Bar Shake has 2310 calories, 266 g sugar and 108 gm fat. You know what they call that Heath Bar Shake? Your Last Meal! Primitive humans hiked, fought and hunted to get just enough food. We get in our cars and drive to “ALL YOU CAN EAT!” Messing with who pays for insurance does not solve the problem of too much food and the pandemic of diabesity and all its downstream dreadful complications. Our only hope: all of us have to eat and live healthfully. At 75 I do walk the talk. I tell my patients and audiences, “If I can do it so can you!”

First off you can’t shoot the messenger Dee, when the message is the problem. The current bill is not the solution to our health care problems. I am fully and totally convinced of that fact.
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Costs are completely out of control, and what does our Government do? Nothing.
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People even if they are lucky to qualify for the new terms this bill provides may still not find a health care provider who will take their “cheap” insurance. As I have predicted in past threads, the only thing this will do is put on a temporary bandaid to a gushing wound that will not stop bleeding.
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Read this article and tell me how this bill will stop this from happening in the future.
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http://nursinglink.monster.com/news/articles/9285-lessons-of-a-weekend-of-free-health-care?utm_source=nlet&utm_content=nl_c1_20100107_freecare
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I can tell you that adding millions upon millions of more “poor” people to the rolls of Medicaid will not fix anything. If anything it will make it more competitive to find a health care provider for them who will accept their low reimbursement Medicaid insurance. Hospitals and ERs, yes. They are required by law to help these folks. But, not your everyday ordinary Physicans.
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This bill does nothing to even remotely take on the problem of out of control costs. Until and when that happens nothing will change. Except the big Drug companies will get richer. Big Insurance companies will have more bodies to bill and most likely at higher premiums than we now have.
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Shooting Karen or any of the other journalist who write about this solves nothing. I do commend and give Karen a ton of credit for bringing this out day after day in hopes that a real reform bill could be passed. But, I am not hopeful at all.
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Until everyone, and I mean everyone marches on Washington, demanding that something be done and done right about health care. Then nothing at all will change.

[...] Follow this link: Health Reform and the States – Swampland – TIME.com [...]

[...] Health Reform and the States – Swampland – TIME.com   « First Edition: January 7, 2010 – Kaiser Health News | The Health Care [...]

Justin Fox (AKA “Curious Capitalist) and I have linked back and forth in the past, and have even used our blogs to answer each other’s questions, but you are right. I will make an effort to do that more often.

KT, that’s the blog where I posted the comment – it was at Barbara Kiviat’s monday post (about bernanke / low interest rates speech). It’s a good blog. Too bad Justin is taking a new job but I’m guessing Barbara will take over. Now imagine that blog doing “1000 words” of Ben Bernanke or Lloyd “Doing God’s Work” Blankfein….

[...] from: Health Reform and the States – Swampland – TIME.com Tags: being-waged, front, lines-for, over-passing, pickert, print, states, the-battle, the-front, [...]

[...] the original post: Health Reform and the States – Swampland – TIME.com var AdBrite_Title_Color = '006DAD'; var AdBrite_Text_Color = '000000'; var [...]

[...] senate, white house, arnold schwarzenegger, Ben Nelson, health reform, medicaid As Karen noted earlier today, she and I have a story in this week's magazine about how much states will be on the [...]

More “irony”
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http://healthaffairs.org/blog/2010/01/07/health-care-reform-state-winners-and-losers/

[...] Kickback," and there would be some kind of more equitable provision to help states deal with their increased Medicaid costs. There would also likely be some kind of revision (and probable retrenchment) on the deal that was [...]