Comments on: HEALTH REFORM: Rich Vs. Poor States: Arkansas Surgeon General On How Income Affects State Innovation

By: Six Conservative Myths About Health Care « Politics or Poppycock

Six Conservative Myths About Health Care « Politics or Poppycock — Mon, 21 Jul 2008 17:46:05 +0000

[...] and a high price tag. Without federal support and redistribution, health care will become less equitable from state to state. What?s more, states with a higher percentage of their population living below [...]

By: Jeanne Keller

Jeanne Keller — Wed, 16 Jan 2008 17:09:42 +0000

As someone who has participated in health reform discussions and initiatives in Vermont for 25 years now, I’d like to bring some facts to the table: Vermont could not be achieving what we are achieving in low uninsured rates if the legislature were actually paying the bill for the Medicaid program and its various expansions, instead of cost shifting to private insurance plans. To wit, a recent study by the state agency that reviews hospital budgets has determined that 44 cents of every dollar that hospitals collect to cover expenses related to Medicaid and expansion beneficiaries comes from overcharges to private insurance. The state legislature has to come up with only 22 cents for every dollar of hospital benefits, and the federal match contributes the remaining 34%. Because the major private carrier in the state negotiates a “discount off charges” contract with hospitals, the cost shift is passed right through. Consequently, 14% our private insurance premiums increases in 2007 can attributed specifically to increased cost shifting, when the legilsature clawed back millions from the hospitals to balance the Medicaid budget. http://www.bishca.state.vt.us/HcaDiv/Data_Reports/legislative_reports/CostShiftTaskForceReport_linked_120106.pdf

The bad policy consequences of this are manifold, among them: legislatures that fund by cost shifting don’t really know how much their Medicaid programs really cost, because state budgets underrepresent the actual outlays. Also, what incentive do hospitals have to economize when private carriers pick up the cost shift tab. Further, would the insured pay this “premium tax” to fund Medicaid if it were imposed openly, instead of covertly?

So, Arkansas, please don’t think that Vermont is ahead on health care reform because we are wealthy, we are “doing well” only because the legislature has found a way to not pay for it, and because private insurance (and the employers who buy it) have not rebelled —- up to now.

A new coalition of hospitals and employers has formed in Montpelier this session under the banner “Fix Medicaid First.” It’s time for the legislators who vote for these expanded benefits to pay for the promises they continue to make.

By: Brad Kirkman-Liff

Brad Kirkman-Liff — Tue, 15 Jan 2008 23:08:26 +0000

States can serve as laboratories for mechanisms and models. The ability of states to experiment with Medicaid has produced stable innovations such as Arizona’s AHCCCS and ALTCS programs which have used competition among capitated manged care plans for over 25 years. They have also produced failures such as Tennesse’s experiment with a related by different model. Many states have experimented with high-risk pools for those in the individual market whom cannot afford experience-rated coverage. The different models of subsidies and risk-pooling provide lessons for states without such programs.

However, in the long-run, only a coordinated national apporach will provide stability to healthcare financing.

By: Cows, Crows & Compost » Blog Archive » US Health Care

Cows, Crows & Compost » Blog Archive » US Health Care — Tue, 15 Jan 2008 04:33:25 +0000

[...] As I was searching for info on the article that Digg linked to, I came across a HealthAffairs.org blog about Health Reform that had some interesting data. The reply to the article by David L Rabin is interesting also. I was thinking about this recently and the general state of welfare and got to the point of trying to answer the question of how social services in general can be provided while still maintaining some incentive to get people to be productive to society. Still working on it along with the whole “size of the central government” and “do / how many Americans even care” questions. [...]

By: Myles Personal Journal » Blog Archive » Narrative Matters: Dad’s Legacy by Jerald Winakur

Wed, 02 Jan 2008 01:55:43 +0000

[...] Ark. Surgeon General On State-Level Reform [...]

By: David L Rabin MD

David L Rabin MD — Thu, 27 Dec 2007 19:59:15 +0000

While there are major differences in the financial ability of states to enact a universal health care access law there are also insurmontable difficulties in maintaining a law, if passed, for all states. There have been at least 9 instances of states passing laws for universal or for substantially improved access for the uninsured.. None have been successful over time.
State budgets are subject to greater variability then the federal budget. Recessions can occur in industries or agricultural products that affect state incomes while the remainder of the country may remain prosperous. Further many states have balanced budget requirements so that, in the event of revenue shortfall, state expenditures have to be cut. Medicaid and related health program expenditures make up a substantial proportion of state budgets. These programs serfve people who are politically weak and poorly organized. They are therefore vulnerable to reductions in health programs when budgets have to be reduced. Expanded access programs become a convenient target for cutting under these circumstances.
History tells us states can not maintain ambitious health programs. It is foolish to ignore that experience and look to states to resolve the national problem of the uninsured, wide social and economic dispariites in use of services, and comparitively poor health status. While health status is only partially addressed by access, covering everyone will focus attention on the need to improve the life style determinants of health; essential to decreasing costly avoidable illness. Attempts to look to the states to resolve the problem of the uninsured is an attempt to delay consideration of access to health care and improvement in health status that other developed nations have addressed. There is no dearth of national experience in financing health care but there is a dearth of national commitment to improve access.
Worse laying off the responsibility for reform to states perpetuates indefinately the issue of containing health care costs. These costs affect the entire population and threaten the coverage of us all. State legislatures are even more subject to interest groups then Congress and these interests have not shown a commitment to containing health care system as compared to service costs. System cost containment is not in their self interest.
We need national not state reform to assure sustainable access and true cost containment.