Is West Virginia Leading The Nation Towards Single Payer Health Care?

Earlier this week the Milwaukee Journal Sentinel reprinted an article in their Ideas Lab from Kaiser Health News reporter Julie Revnor. I have the hard copy but online I found it on the NPR site. The article wrangles with the notion of who is really protecting the Affordable Care Act’s clause to cover Americans with pre-existing conditions. It includes some discussion on the senatorial race in Wisconsin between incumbent US Senator Democrat Tammy Baldwin and her opponent State Senator Republican Leah Vukmir. It is worth the read.

But what caught my attention was the last paragraph where Ms. Revnor is debunking a statement made by the US Senator from West Virginia, Joe Manchin.

Meanwhile, Democrats who are chastising their Republican opponents over the issue are sometimes going a bit over the top, too.

An example is Manchin’s claim about the threat to coverage for 800,000 people in West Virginia. West Virginia’s population is only 1.8 million and more than 1 million of those people are on Medicare or Medicaid. That would mean every other person in the state has a pre-existing condition. A recent study found West Virginia has a relatively high level of pre-existing conditions among adults, but it is still less than 40 percent.

I am not going to fact check Senator Manchin’s claim…the fact that any American might lose coverage because of a pre-existing condition is enough of an issue on its own (full disclosure: I have a pre-existing condition, I had a heart attack in 1999 and am being treated for heart issues to this day). But what I found more interesting was Ms. Revnor’s assertion (and I didn’t fact check that either…she does this for a living so I am taking her at her word here) that over 1 million out of 1.8 million West Virginians are on Medicare or Medicaid. Fifty five percent plus of West Virginia is on federally sponsored single payer health care already. So apparently it works and works fine. So it wouldn’t be much of a push to get those other 44+% of West Virginians on Medicare for All (yes I hate that name because it isn’t factual but I am going to use it because it’s become the vernacular for comprehensive universal single payer health care that I support).

Maybe we should just make West Virginia a test bed and set up a universal single payer plan in just that state. I would think the population would be amenable seeing how the majority are already on similar plans. (just another aside: those on Medicare and Medicaid don’t have to worry about pre-existing conditions. Medicare can’t deny anyone who is old enough to be eligible and Medicaid can’t either and parts of it are essentially designed to cover pre-existing conditions). And it probably won’t be hard to convince the estimated 267,000 previously uninsured West Virginians using the Affordable Care Act to move either.

To me there should be a national move to a comprehensive universal single payer health care system in the United States…but since there is nothing but argument around it…let’s go with a test in West Virginia. It’s a small population…55% are already on a federally run single payer program…and they are close enough to Washington to be a decent social laboratory. Too bad their ‘good neighbor’ to the West (Senate Majority Leader Mitch McConnell) wants to cut back on Medicare and Medicaid. But that might make it easier for WV to volunteer to be the guinea pig here.

BTW: West Virginia’s electoral votes in 2016 went to President Donald Trump who pulled in 68.5% of the vote with only 57.45% turn out.

And this late breaking tidbit. While researching a few of the items above, it looks like Sen. Manchin might not be so far off. This Kaiser Family Foundation chart (from 2015) shows West Virginia having about 35% or so residents with pre-existing conditions that could have been denied coverage pre-ACA. Interesting.

Medicare For All is a crock

Hey…it’s a great campaign slogan…but actually, Medicare For All is a crock…Medicare is an expensive and complicated program that wouldn’t work for the entire populace.

Today Medicare has two basic plans provided by the government. When you sign up for Medicare, Part A, major catastrophic coverage, is touted as free. Well, it isn’t really, you’ve been paying for it your entire working life in your Medicare taxes. The wellness portion, or Plan B, is a charge or premium additional plan. When I enrolled in May, it was $134 per month which they are happily extracting from my Social Security monthly payment. This alone is fairly complicated and not inexpensive…but it barely covers any individuals prospective health care needs. But it is run by the government.

Then comes the Medigap or Medicare supplemental plans. These are run by private insurers based on rules and minimum requirements outlined by the federal government. And there are dozens of these plans…they overlap…they are confusing…and they can cost anywhere from a few dollars a month to hundreds depending on how much you can afford in premiums or how much out of pocket risk you feel you can handle in the future. It is an extremely time consuming and daunting task trying to decide what supplement to select…sheesh. I am not sure I made the right decision and I doubt that anyone else feels much different. And of course it will all depend on your future health needs…and in the short term on what your budget will allow.

But these supplements cover the dreaded prescription drug Part D and provide various amounts of dental and vision coverage, or exposure to co-pays/annual out of pocket costs/deductibles depending on the plan selected. And like most anything to do with health insurance in America, those at most risk are probably least able to afford the coverage they need.

So Medicare For All is a crock…too expensive…too complicated…lacking in comprehensive coverage. So Medicare For All is a crock…unless there is a plan behind the slogan for health care reform that goes far beyond Medicare as we know it.

Like Comprehensive Universal Single Payer Healthcare Coverage. Cradle to Grave, pre-natal to well baby, overall wellness care, flu shots to cancer care, bicycle accident broken arms to bunion surgery, vision care including glasses to cataract surgery, dietary instruction, dental care from baby teeth to braces to implants, mental health care that runs the gamut, physical therapy as needed, diagnostic tests as needed, nursing care from in home to facility, hospice, birth control to fertility care, everything that comes under healthcare to provide each American with an equal chance at life, liberty and the pursuit of happiness. Everyone gets everything…no difference in coverage.

Yes this will cost money. There should be affordable co-pays for doctor visits and more for hospital visits ($20/$40?). Monthly premiums as a % of income withheld by employers just like now…sliding % tho…those at the bottom with little to no participation…those at the top a bigger amount…no caps. Employers pay a % of their total payroll…nobody excluded…simple, easy, just a line item to pay by the accounts payable department.

Major basic advantage to everyone…one plan…one deductible…no out of pocket otherwise…everyone is covered.

Doctors don’t need excess staff to track dozens of different plans and their rules. They don’t have to track what amount to collect as co-pay. They don’t have to play games with charges so they can give discounts to insurance companies. They don’t have to bill and try to collect deductibles from patients after the insurance companies make their determinations. They don’t have to sign up for HMOs or other plans/organizations.

Employers don’t have to have a room full of staff to review plans and interview insurance companies annually. They don’t have to worry about premium increases or deciding which coverage to change (usually reduce) as costs continue to increase. They don’t have to deal with annual open enrollments. No Cobra. And no worrying that a valuable employee will leave for better medical benefits elsewhere. Costs are fixed based on wages.

The federal and state governments can shut down Medicare and Medicaid and Obamacare. Won’t need them anymore. Too complicated, too expensive, obsolete.

So unless there is a real plan to overhaul how healthcare is paid for in the US…to a true comprehensive universal single payer plan as part of that slogan…Medicare For All is a crock.

Where Is The Return On Investment for Single Payer Health Care?

This JSOnline article talks about Governor Scott Walker’s desire to drug test certain Medicaid applicants before they can receive benefits. We’ll get back to that in another post…but the key data point that I wanted to bring up is Wisconsin currently has 1.2 million people on Medicaid.

That population size was a big surprise to me considering the total Wisconsin population is only 5.7 million. So approximately 21% of Wisconsin’s population is on Medicaid…that seems like a pretty substantial number. And of course the state of Wisconsin and the federal government each have bureaucracies to support the implementation of the program and of course spend substantial amount of tax revenues to make it work.

But from a financial and business point of view, when 21% of any market is in play to a single public vendor at what point is it better to push the rest of the market to that vendor? Is 21% the point of ‘return on investment’ that says solidify healthcare to a single payer government program or do we have a bit to go yet?

Well that just gets to the next question. If one simple health insurance plan like Medicaid already provides benefits for 21%, what happens when we add Medicare to our view? There are currently just short of 1.1 million Wisconsinites on Medicare. Essentially another 18% of Wisconsin pays for their healthcare through Medicare.

So that breaks down to about 39% of Wisconsin residents are already being provided with healthcare services through government programs. And I am not even going to include the Veterans Administration here. But I would think 39/40% has to be near the tipping point where it makes sense to enroll everyone in Wisconsin into a single payer plan.

I imagine if we started a state by state comparison we’d find similar relationships across the nation. Let’s try Alabama, the first state on the list alphabetically. Medicaid population: 874,000, Medicare population 968,000 and total state population 4,779,000: 38+%.

At that rate doesn’t it just make more sense to consolidate all health care insurance under one single payer administrator? Cut the overhead, cut the duplication of effort, negotiate better prices and drive efficiencies in health care?

Instead of simply fighting against the American Health Care Act…why aren’t our progressive and liberal electeds fighting for single payer now? Why is it so quiet on the left side of the aisle? It’s time!

Governor Brownback Vetoes Kansas Medicaid Expansion

As I wrote earlier this week, Kansas was one of the red states considering accepting the Medicaid expansion that is part of the Affordable Care Act (aka Obamacare…when can we stop akaing this thing?).

Well the Kansas state legislature passed the bill authorizing the request, but solid gold Tea Party ideologue Governor Sam Brownback vetoed the bill leaving 150,000 low income Kansans from gaining access to health insurance. And here is some of his reasoning:

“I am vetoing this expansion of ObamaCare because it fails to serve the truly vulnerable before the able-bodied, lacks work requirements to help able-bodied Kansans escape poverty, and burdens the state budget with unrestrainable entitlement costs,” Brownback said in his veto message.

First, those who gain health insurance via the Medicaid expansion are certainly poor and by any standards vulnerable people.

Second, this is a health insurance program not a jobs program or educational program or retraining program…he is more than welcome to start any of those he sees fit to start.

Third, the federal government is picking up 90% of the bill and the only ones putting that at risk are his cohorts in the House of Representatives and the White House. But like Governor Walker’s similar excuse…this may be a self-fulfilling prophecy.

And of course there is some opposition to the governor’s position from the very people helping those who are being left out of the health insurance loop, the disabled and partially employed:

Sean Gatewood, spokesman for the KanCare Advocates Network, a group that represents disabled Medicaid beneficiaries, said that Brownback needs to stop using the disability community as an excuse to oppose Medicaid expansion.

“He needs to check the record. The disability community’s 100 percent behind this,” Gatewood said. “People are caught in that gap who have disabilities. They just don’t necessarily meet the Social Security guidelines. He’s completely off base.”

Amy Falk, CEO of Health Partnership Clinic, a safety net clinic network with locations in Johnson County, said that many of the people using her clinics work part time jobs and are not eligible for benefits through their employer. Other patients served by her clinics would have an easier time working if their health needs were addressed.

“We see time and time again, individuals who have chronic health conditions that, if they were managed, could be working, productive members of our community,” she said. “When you’re diabetic and your sugars aren’t right, you’re not going to work.”

She said Medicaid expansion would have enabled Health Partnership Clinic to serve more people.

And then we get to the crux of the matter…Planned Parenthood. Sigh:

Brownback targeted Planned Parenthood in his veto message. The women’s health care provider receives Medicaid reimbursement for birth control, cancer screenings and other services but not abortions as Brownback’s veto message implies.

“Most grievously, this legislation funnels more taxpayer dollars to Planned Parenthood and the abortion industry. From its infancy, the state of Kansas has affirmed the dignity and equality of each human life. I will not support this legislation that continues to fund organizations that undermine a culture of life,” Brownback said. [emphasis mine]

So he opposes funding organizations that undermine the culture of life? What exactly has his organization (the Republican Party) become if not a group that undermines the culture of life? Support life Governor Brownback and support the Medicaid expansion for your own vulnerable citizens!

Hey Kids, Let’s Drug Test Health Insurance Applicants!

As I stated yesterday, in the face of the failure of the GOP bid to repeal and replace the Affordable Care Act, instead of considering accepting the Medicaid expansion like a number of other Republican states, Wisconsin’s Governor Scott Walker wants to move more people off of BadgerCare (the Wisconsin Medicaid implementation).

the governor again rejected the idea of expanding BadgerCare to people with somewhat higher incomes, saying it could make people more dependent on the government.

“My goal is not to put more people on Medicaid. My goal is to get people off,” Walker said.

Instead, Walker is sending a proposal to the Centers for Medicare and Medicaid Services that could affect tens of thousands of childless adults in Wisconsin with incomes below the federal poverty level — $12,060 a year for single adult and $16,240 a year for a couple.

And toward that end he has a number of arcane policy changes to accomplish his goal!

Here’s what Walker wants to do starting in April 2019:

Charge sliding scale premiums of $1 to $10 a month for single adults making $2,533 to $12,060 a year. BadgerCare recipients would have a 12-month grace period to pay past due premiums but if they don’t eventually catch up, they’ll lose their coverage for six months or until they start paying. Emergency visits would also start having copays of $8 for the first visit and $25 for those afterward in a year to nudge people toward cheaper forms of care.

Give premium breaks to recipients who complete a health risk assessment and who don’t engage in risky behaviors such as smoking, obesity, illegal drug use, not using seat belts and alcohol abuse. Recipients can also get the premium breaks if they are working to manage their risk in those areas.

Limit the amount of time on Medicaid for able-bodied workers between 19 and 49 years old to 48 months. After that they would lose coverage for six months. But if recipients are working or getting job training at least 80 hours a month, they could stay on the program for as long as they meet the other requirements.

And then for those of you who were wondering where I got the title for this blog post:

Screen these Medicaid applicants with questions about illegal drug use and actually test some of them for it. Refusing the test will mean the applicants go at least six months without state coverage. If they test positive, the individuals could receive treatment. Toward that goal Walker is asking federal officials to allow for residential substance abuse treatment for childless adults within Medicaid.

I don’t even know where to start…but this may be against the 5th Amendment…it is probably in violation of the Health Insurance Portability and Accountability Act (HIPAA)…may be an invasion of privacy…and may actually deny health insurance to the group of residents most in need of it. And isn’t this one of those things that the GOP always wants to promote in their health insurance schemes…patients working with their own doctors? But Governor Walker hasn’t found a safety net program that he didn’t think he couldn’t improve via drug testing its applicants (i.e. food stamp and unemployment benefits).

Oddly enough, these changes won’t save the state any money even if they are implemented:

These Medicaid changes won’t be cheap — when fully phased in they would cost an estimated $48 million a year in state and federal money and affect about 49,000 childless adults a year, according to the Legislative Fiscal Bureau.

Huh?

And how much do you think it will cost to collect those $1 to $10 monthly premiums?

There are some serious issues in Wisconsin that need some direct and immediate attention. And our governor is dinking around fine tuning something that ain’t broke…and could be improved by accepting the ACA Medicaid expansion? Does this sound like something that will garner votes in 2018? Apparently it does to one person. My goodness!