Login required to started new threads

Login required to post replies

Anyone paying attention to the Medicaid/ACA issue?
Quote | Reply
Heard on the radio this AM that Illinois is something like 1.4B dollars over cost on projected medicaid spending. New applicants were supposed to be 25% LESS expensive then existing applicants and it turned out they are 30% MORE expensive. On top of that they have surpassed the even the highest projected number of signs, not by a little, but by something like 75%.

So I started looking around and found THIS, couple excerpts.

n Medicaid expansion states actual enrollment exceeded potential enrollment by as little as 24% (HI) to as much as 596% (VT)

“Medicaid expenditures are estimated to have increased 12.1 percent to $554.3 billion in 2015. Because the Federal government paid for 100 percent of the costs of newly eligible enrollees and the number of these enrollees doubled in 2015, the Federal share of all Medicaid expenditures is estimated to have increased to 63 percent in 2015 (from 61 percent in 2014), and Federal expenditures are estimated to have grown 16.2 percent to $347.5 billion.

We are expected to spend ~550B on national defense in 2016. Federal Medicaid spending is going to be ~62% of that and total spending will be equal to national defense.

Under Obamacare, Medi-Cal Ballooned to Cover 1 in 3 Californians. “The state’s health plan for the poor, known as Medi-Cal, now covers 12.7 million people, 1 of every 3 Californians. If Medi-Cal were a state of its own, it would be the nation’s seventh-biggest by population; its $91-billion budget would be the country’s fourth-largest, trailing only those of California, New York and Texas…’

In 2014, the average benefit costs of newly eligible adult enrollees are estimated to have been greater than those for non-newly eligible adult enrollees in the program. Newly eligible adults are estimated to have had average benefit costs of $5,488 in 2014, 12 percent greater than non-newly eligible adults’ average benefit costs, which are estimated to have been $4,914.

I'm really not sure how anyone can look at the trends and numbers and think for a second that the path we are on is sustainable. For those proclaiming "We need a public option"...this is it, this is the public option and it's breaking the bank.

~Matt



Quote Reply
Re: Anyone paying attention to the Medicaid/ACA issue? [MJuric] [ In reply to ]
Quote | Reply
Clearly it's not sustainable, and the fact that the insurance companies that are supposed to be supplying the products to the exchanges are leaving ASAP proves that. The tinfoil hat wearing conspiracy theorists may have been right in thinking the first iteration was just a ploy to get to single payer.
Quote Reply
Re: Anyone paying attention to the Medicaid/ACA issue? [ECE] [ In reply to ]
Quote | Reply
The tinfoil hat wearing conspiracy theorists may have been right in thinking the first iteration was just a ploy to get to single payer.

The problem here is that this is not about the exchanges or private industry at all, this is about the expanded medicaid. This IS the single payer option and it's being inundated by cost increases and cost growth that can't be sustained either.

If this doesn't give people pause that the issue is not single payer, private insurance etc etc and that it is nearly ALL about health care cost I'm not sure what will.

We have a health care cost crisis in this country and every single payer system we have, medicare/medicaid/VA is failing to control cost just like the private insurance sector is.

~Matt

Quote Reply
Re: Anyone paying attention to the Medicaid/ACA issue? [MJuric] [ In reply to ]
Quote | Reply
I currently live in this world. The growth in Medicaid enrollment the past few years has been incredible.
Quote Reply
Re: Anyone paying attention to the Medicaid/ACA issue? [dry heat] [ In reply to ]
Quote | Reply
I currently live in this world. The growth in Medicaid enrollment the past few years has been incredible.

Which we kind of expected but part of the expectation was that we would end up having "Lower cost" enrollees. In fact what we had was FAR greater then expected enrollment with significantly higher cost per enrollee.

So in essence, somehow, we have far more people hitting the relatively free health care and at a significantly greater expense.

The greater concern at this point is that a good deal of this cost is supposed to get dumped on the states and few if any of them can handle it. The additional cost will put a serious dent in many states. The increase in cost in 2014 alone would be a 1.5-2% increase on the total state budget for IL. IL is already WAY behind on medicaid payments.

I just don't see this as turning out well.

~Matt

Quote Reply
Re: Anyone paying attention to the Medicaid/ACA issue? [MJuric] [ In reply to ]
Quote | Reply
Quote Reply
Re: Anyone paying attention to the Medicaid/ACA issue? [Swanbird] [ In reply to ]
Quote | Reply
 " Since the "bronze" and "silver" level plans that the president has recently been touting as equaling "the cost of your cable bill" and "less than your cell phone bill" will still entail significant out-of-pocket costs for medical care,

Funny how the Prez. mentioned two things in the private sector where the product/service price is stable or dropping because of competition. Not so much with the un-affordable care act.

I was listening to the Clark Howard show and he was saying nationally one out of every five dollars we spend is on health care.
That is insane to me.
Quote Reply
Re: Anyone paying attention to the Medicaid/ACA issue? [getcereal] [ In reply to ]
Quote | Reply
I was listening to the Clark Howard show and he was saying nationally one out of every five dollars we spend is on health care.
That is insane to me.

It's pretty close to that last I looked, something like 17% of GDP in the US is health care costs. Yes that is insane especially when you start looking at what most people do on a daily basis. Current spending on food is 9.6% GDP, FWIW that is DOWN from 17% in 1960. We spend half as much on food, which all of us use everyday, then we do on health care which many of us use relatively sparingly. I have two guys that work for me that I've been paying insurance for for years. One guy has been on it for nearly 20 years...has never used it.

Of course the opposite is true for others. My son is T1D, we use it every month and he will his entire life sans a cure. We pay considerably more each month for his medical stuff then we do for the food he eats :-)

~Matt



Quote Reply
Re: Anyone paying attention to the Medicaid/ACA issue? [dry heat] [ In reply to ]
Quote | Reply
Medicaid is an unsustainable model. It is mostly used to cover the "poor" and people in nursing homes.

I know several people who have been on Medicaid for years and do not want to do anything to get off of it. One lady was offered a $25/hr job but told the employer to pay her less or she would lose her Medicaid eligibility. So, there are a lot of people on Medicaid who could possibly come off of it but stay in the system and add to the expense.

When I worked in the emergency department, the Medicaid patients would abuse the ER service very badly. They were not paying for it so they had no incentive to watch costs. We would have patients coming to the ER 30-40 times per month because of "my back hurts", "my nose is running", "I just don't feel good", etc......They also had no qualms about calling for an ambulance ride ($500+ per ride to the state, and the tax payers) for completely non-emergent issues. I had a young pregnant lady get an ambulance ride in once because she thought she was having pregnancy related problems. When she thought we were all out of listening range, I overheard her tell her boyfriend "I told you this would get you that ultrasound picture you wanted". She had NOTHING wrong with her. They wanted an ultrasound image of their baby.

This happens all day, every day, all over the US, and it costs an absolute fortune. Many doctors are dropping out because the paperwork is ridiculous and the payments are well below Medicare.

I don't have a solution as to how to fix this problem
Quote Reply
Re: Anyone paying attention to the Medicaid/ACA issue? [eye3md] [ In reply to ]
Quote | Reply
I know several people who have been on Medicaid for years and do not want to do anything to get off of it.

I know a person who is a heavy heroin user that has destroyed their lungs due to their heavy use. They have been on medicare for years and have taken the ambulance ride several times. Once she ended up in the hospital with a collapse lung, spent several day and then a long distance trip to another specialized facility. After 150K in hospital bills for drug induced medical damage she got a free ride home from the sheriff, hour long trip paid for by the tax payers.

Two days later she was back on the streets and doing drugs again....back to the hospital for a couple more days. All in total the bills was over 200K.

I don't have a solution as to how to fix this problem

There are many solutions but they require taking a stance one way or the other. We simply can't continue down the path we are on which in essence attempts to provide all things to all people.

~Matt
Quote Reply
Re: Anyone paying attention to the Medicaid/ACA issue? [MJuric] [ In reply to ]
Quote | Reply
"I don't have a solution as to how to fix this problem "

"There are many solutions but they require taking a stance one way or the other. We simply can't continue down the path we are on which in essence attempts to provide all things to all people."







Why not go back to one of the things that has made our country so great? - The free market-


Health Care is Actually Really Cheap!

https://www.youtube.com/watch?v=_Zdqp22G_K4

Newer 2016 video-

https://www.youtube.com/watch?v=m4Y8vGuBkrk
Last edited by: getcereal: Aug 31, 16 10:45
Quote Reply
Re: Anyone paying attention to the Medicaid/ACA issue? [getcereal] [ In reply to ]
Quote | Reply
Why not go back to one of the things that has made our country so great? - The free market-

Not watched the video but this seems to be a potential solution. There are several doctors forming groups around the country providing services for "Membership" fees. Seems like a potential way to get "Insurance" without the middle man. The Doctors are carrying the risk based on how healthy they keep their patient and thus will more then likely attempt to do what's best for the patient at the lowest cost.

~Matt

Quote Reply
Re: Anyone paying attention to the Medicaid/ACA issue? [MJuric] [ In reply to ]
Quote | Reply
MJuric wrote:
Why not go back to one of the things that has made our country so great? - The free market-

Not watched the video but this seems to be a potential solution. There are several doctors forming groups around the country providing services for "Membership" fees. Seems like a potential way to get "Insurance" without the middle man. The Doctors are carrying the risk based on how healthy they keep their patient and thus will more then likely attempt to do what's best for the patient at the lowest cost.

~Matt

This is how many insurance co (managed care organizations - MCO's)models work as well. Per member per month. Fee for service is pretty rare. It becomes incumbent upon the MCO to keep the population healthy to make any money. The problems mentioned above regarding the Medicaid population are rampant, as well as tons of fraud and abuse. Child enrollment continues to increase. There are many programs and education that goes on from the MCO side, but it is a pretty costly population to manage. The problem with the free market with respect to this population is that for whatever reason, and the children through no fault of their own, they can't really afford ANY care.
Quote Reply
Re: Anyone paying attention to the Medicaid/ACA issue? [getcereal] [ In reply to ]
Quote | Reply
getcereal wrote:
" Since the "bronze" and "silver" level plans that the president has recently been touting as equaling "the cost of your cable bill" and "less than your cell phone bill" will still entail significant out-of-pocket costs for medical care,

Funny how the Prez. mentioned two things in the private sector where the product/service price is stable or dropping because of competition. Not so much with the un-affordable care act.

I was listening to the Clark Howard show and he was saying nationally one out of every five dollars we spend is on health care.
That is insane to me.

I don't know what cable and cell service he has but bronze with a 6000 deductible is a HD cable bill with HBO and showtime and a sports package, plus amazon prime, Netflix, cell phone, a student loan payment and then some
Quote Reply
Re: Anyone paying attention to the Medicaid/ACA issue? [MJuric] [ In reply to ]
Quote | Reply
MJuric wrote:
I was listening to the Clark Howard show and he was saying nationally one out of every five dollars we spend is on health care.
That is insane to me.

It's pretty close to that last I looked, something like 17% of GDP in the US is health care costs. Yes that is insane especially when you start looking at what most people do on a daily basis. Current spending on food is 9.6% GDP, FWIW that is DOWN from 17% in 1960. We spend half as much on food, which all of us use everyday, then we do on health care which many of us use relatively sparingly. I have two guys that work for me that I've been paying insurance for for years. One guy has been on it for nearly 20 years...has never used it.

Of course the opposite is true for others. My son is T1D, we use it every month and he will his entire life sans a cure. We pay considerably more each month for his medical stuff then we do for the food he eats :-)

~Matt



You all realize that Medicaid, Medicare and other programs are a jobs program for the lower middle class, right? Doctors and hospitals get paid shit relatively speaking, you have a huge number of associate and high school degrees running it plus all the support jobs .... look at it like that and it makes more sense
Quote Reply
Re: Anyone paying attention to the Medicaid/ACA issue? [eye3md] [ In reply to ]
Quote | Reply
eye3md wrote:
Medicaid is an unsustainable model. It is mostly used to cover the "poor" and people in nursing homes

To be clear, it is ONLY used for the poor and is the payer of last resort. If a person is dual eligible, Medicare will pay before Medicaid.
Quote Reply
Re: Anyone paying attention to the Medicaid/ACA issue? [dry heat] [ In reply to ]
Quote | Reply
dry heat wrote:
eye3md wrote:
Medicaid is an unsustainable model. It is mostly used to cover the "poor" and people in nursing homes

To be clear, it is ONLY used for the poor and is the payer of last resort. If a person is dual eligible, Medicare will pay before Medicaid.

From that opus that's what you pick out to discuss?
Quote Reply
Re: Anyone paying attention to the Medicaid/ACA issue? [windywave] [ In reply to ]
Quote | Reply
windywave wrote:
MJuric wrote:
I was listening to the Clark Howard show and he was saying nationally one out of every five dollars we spend is on health care.
That is insane to me.

It's pretty close to that last I looked, something like 17% of GDP in the US is health care costs. Yes that is insane especially when you start looking at what most people do on a daily basis. Current spending on food is 9.6% GDP, FWIW that is DOWN from 17% in 1960. We spend half as much on food, which all of us use everyday, then we do on health care which many of us use relatively sparingly. I have two guys that work for me that I've been paying insurance for for years. One guy has been on it for nearly 20 years...has never used it.

Of course the opposite is true for others. My son is T1D, we use it every month and he will his entire life sans a cure. We pay considerably more each month for his medical stuff then we do for the food he eats :-)

~Matt



You all realize that Medicaid, Medicare and other programs are a jobs program for the lower middle class, right? Doctors and hospitals get paid shit relatively speaking, you have a huge number of associate and high school degrees running it plus all the support jobs .... look at it like that and it makes more sense

What do you mean by a jobs program? What roles do the assoc and HS degrees fill? Serious questions, not sure what you're getting at.
Quote Reply
Re: Anyone paying attention to the Medicaid/ACA issue? [dry heat] [ In reply to ]
Quote | Reply
dry heat wrote:
windywave wrote:
MJuric wrote:
I was listening to the Clark Howard show and he was saying nationally one out of every five dollars we spend is on health care.
That is insane to me.

It's pretty close to that last I looked, something like 17% of GDP in the US is health care costs. Yes that is insane especially when you start looking at what most people do on a daily basis. Current spending on food is 9.6% GDP, FWIW that is DOWN from 17% in 1960. We spend half as much on food, which all of us use everyday, then we do on health care which many of us use relatively sparingly. I have two guys that work for me that I've been paying insurance for for years. One guy has been on it for nearly 20 years...has never used it.

Of course the opposite is true for others. My son is T1D, we use it every month and he will his entire life sans a cure. We pay considerably more each month for his medical stuff then we do for the food he eats :-)

~Matt




You all realize that Medicaid, Medicare and other programs are a jobs program for the lower middle class, right? Doctors and hospitals get paid shit relatively speaking, you have a huge number of associate and high school degrees running it plus all the support jobs .... look at it like that and it makes more sense


What do you mean by a jobs program? What roles do the assoc and HS degrees fill? Serious questions, not sure what you're getting at.


All the bureaucracy jobs in the programs like bill processing, call center, eligibility evaluation.... you also have a population that creates demand because healthcare is now free... the number of residency slots hasn't expanded in what 20 years? That means you need more MLP, and low level providers like techs and CNAs. Then you have the same bureaucratic jobs at each hospital that the state has billing etc.
Last edited by: windywave: Aug 31, 16 23:23
Quote Reply
Re: Anyone paying attention to the Medicaid/ACA issue? [windywave] [ In reply to ]
Quote | Reply
windywave wrote:
dry heat wrote:
eye3md wrote:
Medicaid is an unsustainable model. It is mostly used to cover the "poor" and people in nursing homes

To be clear, it is ONLY used for the poor and is the payer of last resort. If a person is dual eligible, Medicare will pay before Medicaid.

From that opus that's what you pick out to discuss?

Already addressed the meat of the opus in a previous post. Just clarifying this particular point.
Quote Reply
Re: Anyone paying attention to the Medicaid/ACA issue? [windywave] [ In reply to ]
Quote | Reply
windywave wrote:
dry heat wrote:
windywave wrote:
MJuric wrote:
I




You all realize that Medicaid, Medicare and other programs are a jobs program for the lower middle class, right? Doctors and hospitals get paid shit relatively speaking, you have a huge number of associate and high school degrees running it plus all the support jobs .... look at it like that and it makes more sense


What do you mean by a jobs program? What roles do the assoc and HS degrees fill? Serious questions, not sure what you're getting at.


All the bureaucracy jobs in the programs like bill processing, call center, eligibility evaluation.... you also have a population that creates demand because healthcare is now free... the number of residency slots hasn't expanded in what 20 years? That means you need more MLP, and low level providers like techs and CNAs. Then you have the same bureaucratic jobs at each hospital that the state has billing etc.

Ahh, so you're saying Medicaid expansion crated a lot of new jobs to manage the higher number of members. I would agree with that to a degree. You still have many of those same jobs anyway, but maybe a shift from one role to another. It's not like the whole population magically expanded. The people in between (without insurance and ineligible for Medicaid) still went to the doctor when needed, and generally the ER. Someone had to pay for that. MCO's are working very hard to educate and reduce the number of inpatient visits to more of an outpatient model, but it's not easy. Behavioral health is a big driver in that area. MLP's etc are still only allowed to do what MLP 's can do, not like a CNA can splint a leg, but that model (PA seeing you for a cold) has been expanding in all aspects of healthcare. CMS is def a big bureaucracy, and federal reporting requirements are certainly a huge effort and cost.
Quote Reply
Re: Anyone paying attention to the Medicaid/ACA issue? [dry heat] [ In reply to ]
Quote | Reply
dry heat wrote:
eye3md wrote:
Medicaid is an unsustainable model. It is mostly used to cover the "poor" and people in nursing homes

To be clear, it is ONLY used for the poor and is the payer of last resort. If a person is dual eligible, Medicare will pay before Medicaid.

Yeah, I put the word "poor" in quotes to emphasize that is the intention of Medicaid but a good number of people in the program should not be there. If you can afford cigarettes and an iPhone then you are not poor, you are making the wrong choices with your limited income
Quote Reply
Re: Anyone paying attention to the Medicaid/ACA issue? [dry heat] [ In reply to ]
Quote | Reply
dry heat wrote:
windywave wrote:
dry heat wrote:
windywave wrote:
MJuric wrote:
I




You all realize that Medicaid, Medicare and other programs are a jobs program for the lower middle class, right? Doctors and hospitals get paid shit relatively speaking, you have a huge number of associate and high school degrees running it plus all the support jobs .... look at it like that and it makes more sense


What do you mean by a jobs program? What roles do the assoc and HS degrees fill? Serious questions, not sure what you're getting at.


All the bureaucracy jobs in the programs like bill processing, call center, eligibility evaluation.... you also have a population that creates demand because healthcare is now free... the number of residency slots hasn't expanded in what 20 years? That means you need more MLP, and low level providers like techs and CNAs. Then you have the same bureaucratic jobs at each hospital that the state has billing etc.


Ahh, so you're saying Medicaid expansion crated a lot of new jobs to manage the higher number of members. I would agree with that to a degree. You still have many of those same jobs anyway, but maybe a shift from one role to another. It's not like the whole population magically expanded. The people in between (without insurance and ineligible for Medicaid) still went to the doctor when needed, and generally the ER. Someone had to pay for that. MCO's are working very hard to educate and reduce the number of inpatient visits to more of an outpatient model, but it's not easy. Behavioral health is a big driver in that area. MLP's etc are still only allowed to do what MLP 's can do, not like a CNA can splint a leg, but that model (PA seeing you for a cold) has been expanding in all aspects of healthcare. CMS is def a big bureaucracy, and federal reporting requirements are certainly a huge effort and cost.

No the expansion had nothing to do with it. Medicaid and Medicare were jobs programs before the ACA. Just pointing that out and that expanding medicaid may have expanded the knock on effect of job creation, but definitely makes cutting the already created jobs harder. (Also those jobs are government union jobs and you know where those dues are going).

Quote Reply
Re: Anyone paying attention to the Medicaid/ACA issue? [windywave] [ In reply to ]
Quote | Reply
look at it like that and it makes more sense

I don't disagree but that doesn't change the idea that it's unsustainable without some serious changes.

~Matt

Quote Reply