Health Care Reform – Medicaid Program Review

January 16, 2010

By Padmini Arhant

The issues that deserve consideration from the individual state standpoint:

Reallocating the Senate offer to Nebraska nationally is a fair approach.

Increasing federal aid in the Medicaid expansion program for 50 states is necessary to deal with the vast uninsured population across the nation.

Since the President and the democratic lawmakers have appropriately incorporated the requirement, it’s constructive to ensure the coverage entirely to avoid rifts between the states.

With regard to the creation of new insurance exchanges under federally regulated marketplaces for consumer choice, it’s important to extend or re-enact the anti-trust laws in addition to the establishment of caps to curb the rising costs especially in the absence of government run insurance program.

The demand and supply determined free market is never inhibited to exercise the freedom to hike the price leading to the status quo.

There is a higher probability in the future, with the demand introduced mandatorily via 30 million and more insured through the proposed legislation. Therefore, it’s vital to close the loopholes presumed to cause the cost factor to rise exponentially.

Upon evaluating California and other states’ grievances in the national health care reform, the following options are viable to resolve the contentious details in the Medicaid program.

In this respect, the State of California is an ideal example with New York State sharing the scenario in terms of the benefits and drawbacks from the current national health care bill.

California is believed to be splitting the costs on Medi-Cal – the state version of Medicaid, the health insurance program for the poor and disabled – in equal ratio with the federal government.

Raising the income threshold under the Medicaid program is a sensitive enactment that would enable the uninsured in millions to qualify for the Federal aid, a crucial component in the legislation.

At the same time, it also enhances the revenue prospects for the insurance industry represented by the health care reform opponents, thereby allowing the free market to thrive and yet vilified by the Republican Senate minority remaining steadfast against the legislation regardless, signifying partisan politics.

The republican stance in any legislation thus far, is clearly anti-populace prioritizing self-interest backed by the special interests over national progress. Similarly, the connotation is extended to the moderates and the conservatives on the democratic side weaving lanes for political security.

Given the eternal gridlock hampering progress more prevalent in the Senate than the House, the adjustment would inevitably yield the desirable result, i.e. coverage for the uninsured provided the market maintains the affordability.

Health Care bill has the federal government absorbing 80 percent of the costs of newly eligible enrollees with the entire costs being paid for the first three years upon the legislation becoming effective in 2013 or 2014.

Although, it’s a positive step in dealing with the burgeoning health care crisis, there are anomalies that could be easily addressed to satisfy the different states’ economic conditions.

For instance, in the 80 percent federal subsidy applied only to newly eligible enrollees, California is confronted with a huge number of people who are qualified for Medi-Cal, but they appear to have not enrolled.

The legitimate concern is the cost burden shifting to the state on equal basis when the compulsory health insurance purchase becomes the law.

Further, the news report titled Health Care – Painful costs of reform for state,

Medi-Cal’s broad mandate would mean greater burden under national overhaul

By Mike Zapler, San Jose Mercury News, January 16, 2010

“The legislation would offer more federal relief to states that now offer Medicaid to only the neediest people, such as Texas and Alabama, than to states that have expanded the program over the years to cover more people, such as California and New York.

California, for example, already will cover a family of four earning up to $23,373, while Texas covers a family of four earning up to only $5,733.

Put a different way, federal largesse would be concentrated on those who don’t qualify for Medicaid currently but would under the new national rules – and California has a lot fewer of them than many other states.

“It is beyond unfair,” Kim Belshé, the governor’s secretary of health and human services, said in an interview. “California is being penalized,” she added, “for having done the right things when times were good.”

Federal regulations make it all but impossible for California to scale back Medi-Cal to cover fewer people, so the state is essentially stuck with generous rules adopted during the flush economic times for it can no longer afford, Belshé, said.

John Holahan, a health care expert at the Washington D.C. based Urban Institute, agreed that it’s “inherently unfair” for the federal government to pay different shares of each state’s health care expansion costs and said it’s bound to create a bureaucratic maze.

“For every new enrollee in each state, they’re going to have to check:

Did they qualify under the old rules or the new rules?” Holahan said.”


Analysis with Solutions: By Padmini Arhant

Even though, the single payer or the public option at the bare minimum would have eliminated these problems, the bill should have provisions allowing the States to adopt the universal plan by preference through state legislature or on a ballot measure.

Nevertheless, in the immediate health care proposal, the practical method is to standardize the eligibility criteria to minimize the cost bearing responsibility at the State level.

Rather than conducting an audit on the qualifying enrollees based on old and new rules that would only escalate the administrative costs, it’s simpler to accept all new enrollees nationwide on federal aid.

Under the existing rule and the pending health care legislation, the state – federal match on health care program is apparently based on the states’ per capita income instead of the poverty rate formula.

Realistically, the poverty rate is an accurate indicator of the uninsured in each state. That being the case, choosing the latter would mitigate the on-going health care costs in the emergency rooms at the County hospitals paid for by the taxpayers.

California’s reimbursement rates to doctors on Medi-Cal program is reportedly the lowest in the country. Accordingly, the Medi-Cal patients are declined by a majority of doctors supposedly struggling to cover the treatment costs.

Moreover, the House version of reform expected to boost Medicaid payments for primary care, whereas, the Senate bill, not surprisingly would not. Again, per the cited article, neither bill would increase reimbursement rates for specialist care.

Such predicaments leave the Medi-Cal patients and the newly insured under Medicaid with insurance coverage,

However, denying them the essential medical service choices.

Hence, the Medi-Cal and Medicaid patient dilemma beckons the network availability with health care providers across the spectrum for meaningful health care access.

Concisely, the micro adjustments on the rules pertaining to the Medicaid program would alleviate the anticipated economic plight for the respective states and pave the way for long-term achievements at the macro proportion in the national health care legislation.

Failure to rectify the inherent inequalities could potentially exacerbate the state deficits inevitably affecting the national GDP.

In this matter, it’s poignant to follow the health care principle:

Prevention is better than cure.

Thank you.

Padmini Arhant

Health Care Reform

July 11, 2009

By Padmini Arhant

The U.S. Senate is reviewing the components of the much-required health care reform bill. Obviously, the free market profiteers represented by the Insurance industry, hospitals, healthcare providers, Pharmaceutical companies and the entire enterprise strongly lobbying against the public option involving federal health care. Simultaneously, a tentative agreement by the hospitals and health care providers to reduce Medicare and Medicaid costs by $155 billion over a decade has been subject to immense speculation.

The opposition minority along with the cynics and the skeptics are vigorously contesting the legislation on the pretext – ‘tax’ and ‘fiscal responsibility’, an all time favorite issue.

Since the national health care estimated to cost over trillion dollars, the debate premised on choice, costs, and quality in accordance with President Obama’s primary objective of this crucial legislation.

Therefore, it’s important to address the concerns and criticisms from the respective quarters in all three perspectives.

Choice or Option:

Evidently, the free market’s resistance via lobbyists against the federal health care confirms the unwillingness to compromise on disproportionate profits at national expense and dominance in the national health care desperately due for major overhaul, even though the opposition minority claims satisfaction with the existing system regardless of the exorbitant costs enforcing the ‘average’ millions to remain uninsured and underinsured.

Unequivocally the present health care is fabulous for the privileged few particularly the lawmakers, the corporate executives and the fortunate healthy population with health insurance in reserve for emergencies. Unfortunately, the same system is neither empathetic nor conducive for those with pre-existing illnesses or children in families with congenital medical conditions and millions simply unable to afford the ‘supposedly’ competitive state of the art health care as declared by the opposition.

The reasons offered by the opposition defending the special interests investing millions of dollars in legislative votes to oppose federal health care, do not correlate with the status quo.

Despite the misnomer that current system is inexpensive without federal health care option, the exclusively private sectors run industry unable to offer any affordable insurance for a sizable population urgently in need of health care.

The real explanation being the system superbly efficient at a premium price, cost effective although draining the national economy predominantly profit driven with an utter disregard for the ethics or economics ultimately hurting the core national base, the vulnerable majority.

It’s clear from the defiance to the public option comprising federal health care viewed as a threat to phenomenal profits by the free market saturating the system with higher costs, limited choice and substandard care through the selection and elimination process leading the other competitors to adapt to similar strategy for survival and success.

Such practices and policies have allowed the free market to override harsh realities experienced by the ailing and dying population deeply affected by the ominous system prioritizing profits over public health.

It’s no surprise that the lobbyists are enabling the selective legislators and the media with the ammunition to curb the federal health care option favoring the entire population wellness against the broken system.

Another form of public option with the co-operatives by non-profit private groups or state run system considered an alternative to the federal health care. Again, it’s not a viable course of action to compete effectively with the health care conglomerate specifically given the dismal fiscal crisis like in the state of California. Nevertheless, the irony in the firm stance against government program is intriguing with the acceptance of states’ operation while rejecting the federal management.

The federal health system foes are fostering ideas and strategies doomed to fail in an effort to prevail in the free market monopoly with some legislators seemingly complicit in the agenda not barring the conflict of interest revealed in the latest disturbing news reports against them.

In the ‘choice’ aspect, the legislators must execute the power granted by their constituents to stand for the people against special interests by enacting the federal health care in public option as an integral part of the health care legislation.

Costs or Funding:

Yet another contentious issue creating huge barriers between the people and the profit seekers supported by the partisans is the trillion dollar costs to fund the program. The self-funding proposal aimed at saving costs from the non-functional system replaced with efficient and innovative techniques along with costs reduction by health care industry should facilitate insurance for the uninsured through federal option.

Conventional wisdom and experience dictates that it’s not possible to derive the trillion dollars funding from savings alone without generating payments from accessible sources – as it is the case in the state or national deficit reduction. Hence, President Obama’s proposal to cap deductions on employee health benefits claimed by corporations is a reasonable approach to health care financing.

Further, costs distribution via nominal tax surcharge applied on avenues earning extraordinary income i.e. over $200,000 for individuals and $250,000 for couples, along with employer contribution through a fee or tax based on percentage of worker’s salary to aid health benefits should adequately solve the equation.

It’s necessary to underscore the surtax and employer contribution fee favoring the small business owners with huge savings in providing the necessary health benefits via federal health care to their labor force, a vital capital resource to survive in the competitive cash strapped economy. Something, the free market could have offered in the non-governmental environment instead stayed focused on exploiting the system with mega profits.

Of course, there is going to be outcry with political humor like – nation socialized with ‘Robin Hood’ motto, President Obama please spare us with your “Change” theme as we might all end up asking one another to spare a ‘change’ in the revolutionary health care reform.

Humor apart, the seriousness lies in the lack of robust competition to keep the costs down and provide quality care. Another opposition’s grievance against federal participation deserves attention i.e. legislators perpetually scornful towards anything to do with their own organization viz. government sponsored projects, programs and services, reaction strangely implying self-deprecation of the political power representing the people.

Interestingly though, such entities are surely elected by their constituents i.e. people in a democracy but they swear allegiance to the Corporations funneling money into their campaigns and beyond.

It’s technically a democracy electing officials to protect the interests of the free market triumphant in widening the gap between the haves and the have-nots aside from dragging the nation to insolvency as witnessed in the finance sector and automobile industry.

In the tax issue, the opposition argument targeted at equalization of tax code. What it means is while the corporations claim deductions from health care benefits to their employees, similar tax relief not extended to private individuals presumably forced to purchase health insurance under the impending plan.

Although, the presentation posed as advocating for the people, essentially it helps the Corporations selling insurance in the strictly private run industry by transferring the liability on to the government through tax credit and revolving back to the tax payer funded health insurance only benefiting the profit seeking corporations rather than the taxpayer themselves.

Clearly, there are many opportunities to provide for the long overdue national health care costs and tragically, the legislative matter politicized by the opponents in compliance with the special interests order.

Care/Quality and Quantity:

The major objection from the opposition is the apparent government rationing of the health care and subsequent effects on the quality citing examples such as the Canadian and the British National Health Care system allegedly dysfunctional because of the government engagement with emphasis on the prolonged waiting period having a direct toll on the patients diagnosed for certain medical conditions. In other words, the deterioration in quality linked to the neglect of preventive medicine proven cost effective than treatment care.

The opposition argument might be legitimate; however, it does not transcend reality.

In this context, the Insurance industry dominated free market authored the “pre-existing” illness code apart from emerging as the champion in discounting and dismissal of genuine medical conditions leading to numerous lawsuits and out-of-court settlements. Notably all of them attributed to negligence and excessive insurance company intervention as evidenced in the grueling and agonizing experiences shared by thousands of victims and health care providers through various outlets.

On several occasions, the pro-health care reformers confronted by the anti-reform movement demanding the name of an international system successfully meeting the national requirements in terms of choice, cost and care. In fact, among the many industrialized nations the Scandinavian country Sweden provides excellent national health care from preventive medicine to cure and the achievement made all possible primarily as the world’s highest taxpayers.

Other hypothesis includes the Medicare and Medicaid payments to hospitals escalating beyond the actual costs over the decade calculated on the number or quantity and not the quality. The private groups reflecting the opposition’s sentiments against the federal health care suggested ‘Pay for quality’ in the bill resembling the Obama plan pledged to promote prevention, treatment and cure.

Amidst agreements and fallouts, a common flaw detected in both groups i.e. the federal system consisting federal agencies for approval on minor to major patient care as a stopgap measure to curtail expenses from medical practices shielding itself against malpractice lawsuits and investment recovery on medical equipments through patient insurance. Any form of over-indulgence will drive the costs in this matter.

It’s best for both federal and private health care to remove bureaucracy and intrusion between patients and health care professionals with unnecessary pre-authorizations causing delay in diagnosis and cost increase. Electronic guidelines on standard medical procedures for common illnesses are an ideal cost reduction method.

Finally, as there are many other issues to address in the immediate future, the analysis with solutions in the health care topic concludes strongly recommending federal run health care as a public option competing on even keel with the private sector to accomplish the general mission – universal health coverage guaranteed to heal the frail economy and the suffering citizens.

Thank you.

Padmini Arhant

National Health Care Day of Service

June 26, 2009

On Wed, Jun 24, 2009 at 12:43 PM, First Lady Michelle Obama wrote:

Padmini —

National and community service has been a cornerstone of my life, as I know it has been for many Americans. And with the daily struggles now confronting so many families, it’s especially important for us to reach out to one another and offer a helping hand.

I’ve just launched United We Serve, a national initiative to tackle our toughest problems by working hand-in-hand in communities across the country. We aim to make a real difference right now and bring more and more Americans into a tradition of life-long service to make an even greater difference down the road.

I’d like to invite you to be a part of it by joining Organizing for America’s National Health Care Day of Service this weekend. You can join up with other local OFA supporters to help improve health care services in your community and make a difference as we work to reform America’s health care system.

Sign up now to participate in a National Health Care Day of Service event this Saturday, June 27th.

There’s an old Thomas Edison quote I’ve always liked: “Opportunity is missed by most people because it is dressed in overalls and looks like work.” It’s no secret that our country faces some enormous challenges right now, and meeting them will take a lot of hard work. But in that work lies an equally great opportunity — a chance to serve. And I do believe the chance to serve is a precious gift indeed.

Service has played a transformative role in my life — bringing me tremendous joy and helping me find the path that led to where I am today. As a parent, I believe service is a great way to demonstrate values and to teach our children firsthand what it means to commit to a purpose beyond ourselves.

It should be a part of everyone’s life. From the moment someone can walk to the day they leave this planet, service should be a part of how we give back, how we say thank you, how we express our gratitude for the lives that we’ve been given.

So I’m deeply honored for this chance to support our United We Serve initiative and Organizing for America, and I hope you’ll be able to participate this weekend. Please sign up now to volunteer at a local event:

Thank you,

First Lady Michelle Obama

On Fri, Jun 26, 2009 at 6:17 PM, Padmini Arhant wrote:

Dear Michelle,

National Health Care Day of Service organized through ‘United We Serve’ initiated by the Corporation for National and Community Service is indeed a great occasion for every American to get involved in raising awareness as well as being part of the solutions to the national crisis – the citizens’ health.

The concept – ‘Health is Wealth’ should not even be a debate leave alone a contentious issue on the ‘Hill’ right now with the weak, fragile and the physically ailing population across the socio-economic strata desperately requiring healing to the prolonged pain and suffering endured by millions every hour.

Several compelling real experiences shared by thousands of affected citizens deserve action since the embattled health care proposal by President Obama brought to national attention for long overdue legislation.

I have no doubt that every caring American generally known for the generosity with their time and resources across the nation and abroad will respond to community service in any aspect regardless of political affiliations.

I wish the “United We Serve” success in the dedication to humanitarian service.

Thank you for the opportunity to be part of the worthy cause.

Best Wishes

Padmini Arhant