Senate panel backs amendment permitting state health-care plans (click title to entry - thank you)
Posted on Thu, Oct. 01, 2009 06:24 PM
By the narrowest of margins, the Senate Finance Committee on Thursday approved an amendment by Sen. Maria Cantwell that would allow other states to establish basic health care plans for low-income residents similar to the one in Washington state, but with the federal government providing the funding.
Cantwell, D-Wash., declined to liken her proposal to a controversial public option, which has become a major sticking point in health care reform. But it does allow the states, if they choose, to negotiate with insurance companies for lower rates on health coverage polices for those living barely above the poverty line and provides federal dollars to pay for it.
Cantwell said her proposal would cover about 75 percent of those who currently don't have health insurance.
The amendment to a health care bill written by Montana Democratic Sen. Max Baucus, the committee chairman, was approved 12-11. All of the committee's Democrats except for Sen. Blanche Lincoln of Arkansas supported Cantwell's amendment, while all of the Republican members opposed it....
My son is getting married on Saturday and the rehearsal dinner is tomorrow evening, so I am a little busy but I will do what I can and will keep one ear to the ground. I would like to be back on track by Monday.
The kids will be on their Honeymoon by then. Lucky, lucky, lucky. I sent them on a shopping spree for Honeymoon clothes as a Bridal Shower Gift. They thought it was a great idea. They only go around once, ya know? My son and I are great friends.
My country, under the leadership of President Obama and my countrymen are important to me, too. I really feel like we are making progress within our democracy again. I am very hopeful about the future in the USA. Barak is a good man.
I just feel with all the viciousness toward him within the country I can't completely take a couple days off. I don't trust the Republicans that far. I just don't. They have hurt this country a great deal and President Obama is making historical strides in solving so many problems. We are going to be okay.
I left off with page 750 of the House Health Care Insurance Reform Bill. I am going to back up a little bit, because there is a section on Medicaid I doubt I covered last time. Might have glossed over it, but, didn't really 'get into it.'
Page 746, beginning with line 5 through 11:
SEC. 1702. REQUIREMENTS AND SPECIAL RULES FOR CERTAIN MEDICAID ELIGIBLE INDIVIDUALS.
(a) IN GENERAL.—Title XIX of the Social Security Act is amended by adding at the end the following new section:
‘‘ REQUIREMENTS AND SPECIAL RULES FOR CERTAIN MEDICAID ELIGIBLE INDIVIDUALS
This continues to discuss the 'public option' in the House Bill. It involves additional provisions to Medicaid. At least that what it appears like at first glance. I haven't read the Senate bill yet. I think it is about 650+ pages. But, perhaps the Senate and House are in agreement more than we thought.
Page 746, lines 12 through 25 and Page 747, lines 1 and 2;
‘‘SEC. 1943. (a) COORDINATION WITH NHI EXCHANGE THROUGH MEMORANDUM OF UNDERSTANDING.—
‘‘(1) IN GENERAL.—The State shall enter into a Medicaid memorandum of understanding described in section 204(e)(4) of the America’s Affordable Health Choices Act of 2009 with the Health Choices Commissioner, acting in consultation with the Secretary, with respect to coordinating the implementation of the provisions of division A of such Act with the State plan under this title in order to ensure the enrollment of Medicaid eligible individuals in accept24
able coverage. Nothing in this section shall be construed as permitting such memorandum to modify or vitiate any requirement of a State plan under this title.
Evidently, the States are going to be conducting the Medicaid portion of the Public Option. They do that now. The State oversees the 'qualification' for Medicaid. That qualification is conducted at the county level usually. It is followed up by a Social Worker, I believe. But, the Federal Government pays for it. Or pays for the majority of it.
The provision goes on to state there are Traditional and Non-Traditional enrollees. The Non-Traditional enrollees receive "affordability credits."
Page 748, lines 15 through 18;
...by the Commissioner of eligibility for affordability credits under subtitle C of title II of division A of the America’s Affordable Health Choices Act of 2009, as specified under such memorandum.
Page 479, lines 3 through 22;
‘‘(3) DETERMINATIONS OF ELIGIBILITY FOR AFFORDABILITY CREDITS.—If the Commissioner determines that a State Medicaid agency has the capacity to make determinations of eligibility for affordability credits under subtitle C of title II of division A of the America’s Affordable Health Choices Act of 2009, under such memorandum—
‘‘(A) the State Medicaid agency shall conduct such determinations for any Exchange-eligible individual who requests such a determination;
‘‘(B) in the case that a State Medicaid agency determines that an Exchange-eligible individual is not eligible for affordability credits, the agency shall forward the information on the basis of which such determination was made to the Commissioner; and
‘‘(C) the Commissioner shall reimburse the State Medicaid agency for the costs of con22
ducting such determinations.
All that is self explanatory. An individual or family applies for 'affordability credits as an 'exchange-eligible individual' and then the application is reviewed and either granted or denied. At any rate, if there is a denial by the State, that denial will go to the Federal government.
I already wrote about the baby thing, whereby, they are presumed eligible at birth to insure their medical care until they can be evaluated, or their parents are evaluated for eligibility. That goes on to at least page 750.
Oh, I'll read the Senate bill. The truth is the truth. Whether it passes or not, understanding the legislation is vital. If the Senate bill is research and written as well as the House bill it will be a good read.
Okay. Under this provision, the State will have jurisdiction over qualifying for enrollment, but, the Federal government sets the 'standard.' The word standard is my word, not theirs.
Page 753, lines 1 through 11;
...quarters beginning after the date of the enactment of this subsection and before CHIP MOE termination date specified in paragraph (3), a State shall not have in effect eligibility standards, methodologies, or procedures under its State child health plan under title XXI (including any waiver under such title or under section 1115 that is permitted to continue effect) that are more restrictive than the eligibility standards, methodologies, or procedures, respectively, under such plan (or waiver) as in effect on June 16, 2009.
Part of what is happening with these bills is an absorption of other health care titles still in enforcement. I thought that would happen. I speculated about that before.
Page 754, lines 1 through 14;
‘‘(A) The Health Choices Commissioner has determined that the Health Insurance Exchange has the capacity to support the participation of CHIP enrollees who are Exchange-eligible individuals (as defined in section 202(b) of the America’s Affordable Health Choices Act of 2009),
‘‘(B) The Secretary has determined that such Exchange, the State, and employers have procedures in effect to ensure the timely transition without interruption of coverage of CHIP enrollees from assistance under title XXI to acceptable coverage (as defined for purposes of such Act).
So, basically the States will be paid as long as they abide by the federal standards for this provision.
The next provision is controversial. It is about cutting the expenses within the Medicaid and Medicare program. It is about reducing the monies paid to the DSH (Disproportionate Share Hospital). I am going to provide a reason why this is not as bad as it seems. But, first the provision, then an article and then I'll follow up with an explanation.
Page 759, lines 8 through 14;
(b) MEDICAID DSH REDUCTIONS.—
(1) IN GENERAL.—The Secretary shall reduce Medicaid DSH so as to reduce total Federal payments to all States for such purpose by $1,500,000,000 in fiscal year 2017, $2,500,000,000 in fiscal year 2018, and $6,000,000,000 in fiscal year 2019.
This is an article from the website for the AHA (American Hospital Association). The AHA is concerned with administrators of hosptials and the monies they receive for operation of hospitals. The AHA is a good organization. It sets all kinds of rules and regs for hospitals, their personnel, etc. The article below outlines the controversy.
Safety-net hospital leaders see DSH cuts as roadblock to health reform (click here)
June 22, 2009
Safety-net hospital leaders say President Obama's proposal to cut $106 billion in Medicare and Medicaid Disproportionate Share Hospital (DSH) payments over the next 10 years marks a wrong turn on the road to health care reform.
"Those cuts would affect our viability … the lifeline of our institution," says John Bluford, president and CEO of Truman Medical Centers (TMC) in Kansas City, MO.
The DSH proposal would reduce TMC's Medicaid reimbursements by nearly $50 million a year. About half of the patients who enter TMC's doors are Medicaid beneficiaries; nearly 30% of its patients are covered by Medicare.
There are not enough efficiencies for us to make up for the loss in that level of funding," Bluford says. "This is about protecting the safety net and providers who represent the medical homes for hundreds of thousands of patients."
The president on June 13 called for the DSH cuts – a 75% reduction in funding for the programs – as part of a proposal to cut health care spending by $313 billion over 10 years to help finance health reform. Of that amount, some $220 billion would be chopped from hospital funding, including $110 billion in across-the-board "productivity adjustments" to Medicare payment increases....
First, what is a DSH? A DSH is a hospital that receives higher than average numbers of indigent people. The DSH receives additional funding for supplying health care to these folks. It is a cut in that extra funding the AHA is complaining about. And, of course, where there is cut in the funding they are concerned they will not be able to provide care to the people they normally treat. Reasonable thought. A little surprising, because, this is not as bad as it seems.
The DSHs of the country are the ones that get a lot of uninsured. Okay? What is this bill going to do? It is going to insure the uninsured. Are you following me here?
Over the next ten years, these bills will provide insurance for the uninsured and the cost to DSH hospitals for the uninsured will come down. As more and more citizens are insured, the hospitals will be getting compensated for their 'actual' costs within the Medicaid and Medicare program. So, if the 'subsidies' to the DSHs continued as well as the uninsured being insured, the hospitals would actually be 'double dipping.'
As much as 25% of the subsides to the DSHs will continue because they also treat people whom are not citizens. The hospitals of the USA are not supposed to turn anyone away at their emergency rooms. So, if illegal aliens come to the ER they are going to receive treatment. That is all uncompensated treatment. So, 25% of the subsides will remain to pick up the slack for those people that still go to the DSHs without insurance.
I am confident, that over time, if the DSHs can provide concrete proof they are still losing more monies than they are being reimbursed, the legislature can readdress the problem, but, I don't believe that will be the case. The AHA needs to regroup in their assessment of these bills and ask their member hospitals to keep good records in regard to this group of people whom receive treatment at these hospitals. I commend the AHA for being as concerned about DSHs as they are all other hosptials.
The provisions of this aspect of this bill are very logical. The largest reductions will be in States with the lowest percentages of uninsured. These States will be better prepared for the reduction when it happens and will be able to control any of the outcomes should they be different than what is expected. I caution here. At the point where reductions to DSHs occur, they will probably be seeing larger revenues from insurances. The reductions will be nearly invisible to the hospital in question.
Each year, in keeping with transparency, the allotment of DSH payments will be published in the Federal Register to insure equity in decision making. The provision goes on to be sure the programs administered by the DSHs are non-discriminatory and July 1, 2010 is the date when this provision would begin to take effect, unless, all safeguards are not in place.
There is a change in subject beginning with Page 765.
Subtitle B—Prevention
SEC. 1711. REQUIRED COVERAGE OF PREVENTIVE SERVICES.
Same page, lines 18 through 25;
‘‘(1)(A) recommended with a grade of A or B by the Task Force for Clinical Preventive Services;
or
‘‘(B) vaccines recommended for use as appropriate by the Director of the Centers for Disease Control and Prevention; and
‘‘(2) appropriate for individuals entitled to medical assistance under this title.’’.
It appears Smoking Cessation medications aren't going to be paid for anymore. There will be home care visits allowed for mothers of newborns and children of abuse/neglect.
Page 768, lines 20 through 24 and page 1 through 14;
‘‘(aa) The term ‘nurse home visitation services’ means home visits by trained nurses to families with a first-time pregnant woman, or a child (under 2 years of age), who is eligible for medical assistance under this title, but only, to the extent determined by the Secretary based upon evidence, that such services are effective in one of more of the following:
‘‘(1) Improving maternal or child health and pregnancy outcomes or increasing birth intervals between pregnancies.
‘‘(2) Reducing the incidence of child abuse, neglect, and injury, improving family stability (including reduction in the incidence of intimate partner violence), or reducing maternal and child involvement in the criminal justice system.
‘‘(3) Increasing economic self-sufficiency, employment advancement, school-readiness, and educational achievement, or reducing dependence on public assistance.’’.
(b) EFFECTIVE DATE.—The amendments made by this section shall apply to services furnished on or after January 1, 2010.
Page 770, lines 3 through 6; The Right Wingers won't like this. This is an opportunity to introduce a concept that provides insight to economical reasons for family planning. Don't prejudge this;
SEC. 1714. STATE ELIGIBILITY OPTION FOR FAMILY PLANNING SERVICES.
(a) COVERAGE AS OPTIONAL CATEGORICALLY NEEDY GROUP.—
Page 771, lines 3 through 11;
(B) by inserting ‘‘, and (XV) the medical assistance made available to an individual described in subsection (hh) shall be limited to family planning services and supplies described in section 1905(a)(4)(C) including medical diagnosis and treatment services that are provided pursuant to a family planning service in a family planning setting’’ after ‘‘cervical cancer’’.
Ever hear of the name Thomas Robert Malthus? He was a British scholar. His works were said to inspire Wallace and Darwin. But, his speciality was not evolution so much as political eonomy and demographics.
Thomas Malthus focused a great deal on population growth. He stated as society improved conditions for life, there was a counter balance such as famine or disease that would stabilize the population. Thomas Malthus was a clergyman. He was called Reverend Thomas Robert Malthus.
He wrote a book in 1798, entitled "An Essay on the Principle of Population." It was a very influential book for its time. It was the 6th edition that was believed to have been read by the collegues Darwin and Wallace. Now, don't close your mind to what he wrote. He was a holy man and just because Darwin and Wallace read his book and found inspiration doesn't mean that Reverend Malthus was a man to be disregarded. Quite the contrary. His writings made too much sense.
Within the book on the Principle of Population there was a section that became known as, Malthus' Iron Law of Population. It theorized that growing population rates would contribute to a rising supply of labour that would inevitably lower wages. In essence, Malthus feared that continued population growth would lend itself to poverty.
See, Malthus was a holy man. He didn't worry about HAVING cheap labor to facilitate profit, he worried about 'the state of living.' The quality of life. He didn't want his flock ending up impoverished because their population had so many members that they became DIRT CHEAP labor.
He's right, you know. The more people there are to provide labor, the less the wages will be. There are examples of that all over the world. Outsourcing of American jobs have went to countries with high population rates, impoverishment and cheap labor. Don't say they haven't, because it is a known fact. So, Reverend Malthus is correct. On all counts.
When I reflected on Reverend Malthus teachings in attempts to stem poverty; I also reflected on the 'state' of the priorities of the Republican Party. See, the Republicans are 'religious' right wingers that believe in uncontrolled population growth while allowing illegal immigration into the USA, unchecked. We know in this country, that for a long time, the porous Texas border was a welcome commodity to the people that would employ the illegal aliens to enhance their profit.
When I reflected on Reverend Malthus and his concern for quality of life with high population rates, I attempted to understand why in the year 2009, after eight years of religious fervor that would like see the end of birth control and abortion while removing sex education from schools; the USA was becoming more and more demoralized within the concept of 'responsible' population growth. After all. An economy is as strong as its participants that purchase the goods of supply and demand.
Why then. With theorists, like Reverend Malthus, whom anyone majoring in economics, especially at Harvard, would there be such wide spread religious fervor unchecked? Why was it not only unchecked, but, emphasized?
Why in an era of a warming planet, food shortages, droughts and water shortages would an entire American political party be so willing to encourage 'irresponsible' child bearing when they knew full well it would lead to wider spread poverty, impoverishment and less ability for any one consumer to purchase items in a 'capitalistic' supply and demand society?
It couldn't possibly be that the Republicans knew Reverend Malthus was more than correct, but, more a pure genius that would show them how to insure having any country rich with cheap labor. That couldn't be, now could it? Why cut off funding for Family Planning clinics in impoverished areas of the world on the first day of office in the year 2000? Why, indeed.
Got a little off the beaten path. So, where was I?
The provision continues that the family planning aspect of the bill is presumptively eligible initially.
That takes me to page 775 and a time of 11:24 PM.
Until later...have a good day.
