Impeding changes to our Health Care system

[Clodfobble]

Maybe Nevada has significantly more low-income residents than other states. So when the Feds raise the income bracket of people eligible for Medicare, maybe that saddles Nevada with 3 million new users to pay for, while maybe Virginia would only have to deal with 250,000. (Numbers pulled out of my ass for illustration.) I wonder what the other three states are...

Originally Posted by classicman

Whats good for the rest of the nation apparently isn't good for Nevada. WTF is this and why isn't anyone outraged?

link

Why is it fair for all the other states to pay and not his??? This is the kind of BS that really pisses me off. Basically they are either adding to the cost of the program or taking money from other states. Either way it seems very wrong.

Under the current law, states can never pay more than 50% of the Medicaid costs, with the feds picking up the rest.

In most states, the fed taxpayers (you and me) are paying more than 50 percent (in some states, much more) based on the current cost sharing formula. In Nevada and a few other states, it is a 50-50 split.

Increasing the number of eligible residents for Medicaid in NV may have pushed that state share above 50% which would be contrary to the limit in existing law.

A chart

http://facts.kff.org/chart.aspx?cb=56&sctn=152&ch=991

So, in fact, you and I have been paying less for Medicaid in Nevada than we pay for most other states and I suspect, even with these provisions that Reid added, we would still be paying less in NV than the national average.

[TheMercenary]

FMAP is not just Medicaid.

Federal Medical Assistance Percentages (FMAP) are the percentage rates used to determine the amount of matching funds that are allocated annually to certain medical and social service programs in the United States of America. FMAP eligible programs are joint federal-state partnerships between the federal government of the United States and state governments, which are administered by the states.[1][2]

Funds that are eligible for FMAP match include Medicaid, State Children's Health Insurance Program (SCHIP) expenditures, Temporary Assistance for Needy Families (TANF) Contingency Funds, the Federal share of Child Support Enforcement collections, and Child Care Mandatory and Matching Funds of the Child Care and Development Fund.

State governments use FMAP percentages to determine the federal government's contribution to specific state administered programs and assess their related budgetary outlays. For example, the 2006-2007 FMAP rate for California was 50% - therefore, for every dollar that California contributed to an eligible social or medical program between 2006 and 2007, the federal government also contributed one dollar.

from Wiki.

The "Federal Medical Assistance Percentages" are for Medicaid. Section 1905(b) of the Act specifies the formula for calculating Federal Medical Assistance Percentages as follows:

"Federal medical assistance percentage" for any State shall be 100 per centum less the State percentage; and the State percentage shall be that percentage which bears the same ratio to 45 per centum as the square of the per capita income of such State bears to the square of the per capita income of the continental United States (including Alaska) and Hawaii; except that (1) the Federal medical assistance percentage shall in no case be less than 50 per centum or more than 83 per centum, (2) the Federal medical assistance percentage for Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa shall be 50 per centum."
Section 4725(b) of the Balanced Budget Act of 1997 amended section 1905(b) to provide that the Federal Medical Assistance Percentage for the District of Columbia for purposes of titles XIX and XXI shall be 70 percent. For the District of Columbia, we note under the table of Federal Medical Assistance Percentages the rate that applies in certain other programs calculated using the formula otherwise applicable, and the rate that applies in certain other programs pursuant to section 1118 of the Social Security Act.

Actual numbers by state:

http://aspe.hhs.gov/health/fmap10.htm


Nevada is 50.16 percent paid by the Fed.

Originally Posted by TheMercenary

FMAP is not just Medicaid.

Nevada is 50.16 percent paid by the Fed.

Right.

The FMAP formula is used to determine state/federal shares for more than just Medicaid.

More on FMAP and the federal share of Medicaid costs, if anyone really cares:
http://www.nhpf.org/library/the-basi...P_01-15-09.pdf

The statute establishes a minimum FMAP of 50 percent for states, stipulating that no state shall bear more than 50 percent of total costs, regardless of the result of applying the formula. Thirteen states have FMAPs equal to the 50 percent floor in FY 2009. The statute also contains an upper FMAP limit of 83 percent.

Adding a few more million Nevada residents to be eligible for Medicaid would probably put the state cost-sharing percentage over 50% UNLESS the federal share pays 100% for those newly added millions...at least in the short term.

I dont see where Reid did anything wrong here for Nevada and 2-3 other states that are at the state limit on cost-sharing. In fact, I dont know why he didnt include all 13-14 states already at the 50% match, unless there are specific demographic differences among these states that make the fiscal impact of providing Medicare eligibility to more residents significantly greater on some of those states than others.

[classicman]

Originally Posted by Redux

I dont see where Reid did anything wrong here for Nevada and 2-3 other states that are at the state limit on cost-sharing. In fact, I dont know why he didnt include all 13-14 states already at the 50% match, unless there are specific demographic differences among these states that make the fiscal impact of providing Medicare eligibility to more residents significantly greater on some of those states than others.

Perhaps they're primarily Republican states.

Originally Posted by classicman

Perhaps they're primarily Republican states.

If you look at the map I posted earlier, you will see that, with the exception of WY, nearly all of the 13-14 states at the 50% match level are Democratic states...or a few swing states like CO and VA.

Nope...doesnt fly.

[classicman]

I WAS KIDDING! Sheesh a lil levity and all ya know. Hold your mouse over the smiley?

I still think it doesn't need an amendment. Isn't/shouldn't that be written in there already? I think it looks bad and stinks - especially coming from one of the leaders of the party.

Originally Posted by classicman

I WAS KIDDING! Sheesh a lil levity and all ya know. Hold your mouse over the smiley?

I still think it doesn't need an amendment. Isn't/shouldn't that be written in there already? I think it looks bad and stinks - especially coming from one of the leaders of the party.

I just cant help myself.

I see attempts at "gotcha Obama/Democrats" in so many posts, and more often than not, without having all the facts. (More from Merc than you)

An image flashes in my head each time.

“Always with the negative waves, man!”

[Pico and ME]

Awww...bringing up Kelly's Heroes. How cool is that.

[TheMercenary]

By Jacob Goldstein
The Congressional Budget Office just released its estimates for the Senate Finance Committee’s big health-care bill. (Here’s the WSJ story.) The bottom line: CBO estimates that the bill will shave more than $80 billion off of the federal deficit over a 10-year period.

Here are five key numbers from CBO:

94%: The percentage of legal U.S. residents under 65 who will have health insurance in 2019. That’s up from about 83% today. The bill doesn’t provide coverage for illegal immigrants. U.S. citizens 65 and older already have near universal access to health insurance, through Medicare.

29 million: The decrease over a decade in the number of people who are under 65 and uninsured.

25 million: The number of people under 65 who would still be uninsured in a decade. About a third would be illegal immigrants.

$829 billion: The gross total cost to the federal government, over 10 years, of expanding insurance coverage. This includes credits and subsidies to help people buy insurance on exchanges; higher funding for Medicaid and the Children’s Health Insurance Program (CHIP); and tax credits for small employers.

$911 billion: Savings and new revenue, over 10 years, resulting from the bill. Among the contributors: A new tax on so-called Cadillac health-insurance plans (initially defined as those with annual annual premiums over $8,000 for individuals and over $21,000 for families, with some exceptions).

Bonus Number: The CBO estimates that only $3 billion of an allotted $6 billion will be spent for the non-profit insurance co-ops described in the bill. The co-ops got a lot of attention in the health-care debate this summer, but CBO says “they seem unlikely to establish a significant market presence in many areas of the country or to noticeably affect federal subsidy payments.”

http://blogs.wsj.com/health/2009/10/...l/?mod=blogmod

Not discussed:
How they are going to cut Medicare Advantage and how that will affect seniors that depend on it, esp in rural areas.

There are still a lot of amendments to go through.

The CBO calculations only take into account the proposed bill, not the potential for employers to take the penalty hit and pass the empolyee off to what ever plan they can find out there under the big mommy of the Fed.

[TheMercenary]

WASHINGTON (CNN) -- A compromise health care proposal widely seen as having the best chance to win Democratic and Republican support would cost $829 billion over the next 10 years, nonpartisan budget analysts concluded Wednesday.


It also would reduce the federal deficit by more than $80 billion, according to a report from the Congressional Budget Office.

The review of the Senate Finance Committee's amended bill sets the stage for the next step in the politically charged debate over health care reform. Committee members have been waiting for the Budget Office's cost analysis before voting on their version of the bill.

The Finance Committee is the last of five congressional panels to consider health care legislation before debate begins in the full House and Senate.

The Budget Office's analysis differs slightly from Finance Committee Chairman Max Baucus' estimate. Baucus, a Montana Democrat, had said the revised bill would cost roughly $900 billion.

Over the past two weeks, the Finance Committee has considered several hundred amendments to the sweeping bill. Committee members boosted the bill's overall price tag in part by voting to exempt senior citizens from higher taxes on medical expenses.

Before the amendments, the Budget Office projected that the committee's version of the bill would cost $774 billion; Baucus estimated that it would cost $856 billion.

http://www.cnn.com/2009/POLITICS/10/...are/index.html

[TheMercenary]

Unintended consequence looms large over plans for healtcare reform bill.

Waves of new fund cuts imperil US nursing homes

HARTFORD, Conn. – The nation's nursing homes are perilously close to laying off workers, cutting services — possibly even closing — because of a perfect storm wallop from the recession and deep federal and state government spending cuts, industry experts say.

A Medicare rate adjustment that cuts an estimated $16 billion in nursing home funding over the next 10 years was enacted at week's end by the federal Centers for Medicare and Medicaid Services — on top of state-level cuts or flat-funding that already had the industry reeling.

And Congress is debating slashing billions more in Medicare funding as part of health care reform.

Add it all up, and the nursing home industry is headed for a crisis, industry officials say.

"We can foresee the possibility of nursing homes having to close their doors," said David Hebert, a senior vice president at the American Health Care Association. "I certainly foresee that we'll have to let staff go."

http://news.yahoo.com/s/ap/20091004/...sing_home_cuts

[TheMercenary]

So it really does not fix the problem and it is all just a guess...

$800 billion bandaid:

The bill would leave 25 million Americans uninsured - fully 6% of the population, excluding illegal immigrants, according to the CBO. But it would result in coverage for 29 million who currently do not have insurance, the CBO said.

The $829 billion cost of subsidies in the bill was up from a $774 billion, 10-year estimate delivered by the CBO on Sept. 16, before Finance Committee members voted to boost subsidies to lower- and middle-income Americans, among other changes.

The CBO projected that the revenue from the insurance excise tax and other sources will grow more quickly from 2020 to 2029 than the parts of the bill that cost the government - amounting to a net reduction in the federal deficit. But the CBO cautioned its projection is "subject to substantial uncertainty."

http://online.wsj.com/article/BT-CO-...07-714575.html

I get it. You just need something new to bitch about because you dont like the CBO total cost and deficit reduction numbers.

If an Obama/Democratic program is less than 100% perfect and does not solve or address a problem in the way that you believe is best, then it is a failure.

“Always with the negative waves, man!”

[TheMercenary]

Originally Posted by Redux

I get it. You just need something new to bitch about because you dont like the CBO total cost and deficit reduction numbers.

If an Obama/Democratic program is less than 100% perfect and does not solve or address a problem in the way that you believe is best, then it is a failure.

“Always with the negative waves, man!”

And why would you say that? This is the first look that we are getting at the details of the Senate plan minus the numerous amendments that are going to attempted to be lumped on as it moves on through the process. The time to pick it apart is as it moves through the process, not at the end when Pelosi, Reid, and Rahm it Home Emanuel trys to screw us with last minute manipulations and add-ons.

The CBO estimate is but one step in that process and you know that. There is still much we don’t know and at this early stage there are already cracks in the plan. Some people may blindly accept the change because all they know is that they will be getting something for nothing, when in fact they will be paying a larger part of their income for whatever they currently have. Some of that is positive, although there is great potential for abuse as there are currently no provisions to prevent medical device corps, big pharm, or employers from passing on costs to the consumers. There is also frank discussions about how many employers may find that paying a penalty to the feds is a much cheaper route than providing health care to the employees, some thing I have mentioned a long time ago and throughout this process. Then how do they deal with the people who still can’t afford healthcare or the personal penalty ala the current situation in Mass.?

I will be holding Obama and the Demoncrats to all the promises they made to the American public which got people to vote for them and propel them to their present state of power. They get it all, all the success and all the failures. I also will be looking out for my best interest as a participating member of the business of healthcare. The current plan as it is moving through the Senate fails to provide healthcare to all legal citizens nor does it address the root problems in our system. I predict it is doomed to failure even though my great grand children, along with the rest of us, will still be paying for this mess. Deficit neutrality is a farse.