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Governor Patrick’s Budget on Health Care: Playing Around the Edges

January 28, 2011 By josh_pioneer

The budget grants the MA Secretary of HHS authority to change benefits and eligibility in MassHealth when possible- however her actions are restricted by the many constraints placed on the state by the federal government in the stimulus and Obamacare. 33 Governors sent a letter  to the federal HHS asking for greater flexibility on Medicaid because it is killing their budgets. Keep in mind that MA is currently much higher as a % of our budget spent on Medicaid compared to these other states. The national average is closer to 21%.

The Administration mentions undertaking “several other steps such as constraining provider and capitation rates” to contain costs- in other words $150 million in rate cuts for hospitals and other providers . This will only decrease access for patients as fewer doctors accept Medicaid patients, provides an incentive for doctors to run more tests to make up for the lower rates of reimbursement OR for hospitals to charge more to make up the difference from those coming in with commercial insurance.  

It is time the Governor and his staff seriously consider a global waiver application for Medicaid, following in Rhode Island’s footsteps.

Other items that drew my eye were:

Commonwealth Care Bridge Program Reauthorization

To cover health insurance for legal immigrants. The cost for 5-months this year was $20 million. Now the Administration has set aside $50 million for a year, and if that is not enough money, they will drop that money into the Health Safety Net Trust Fund (also known as the uncompensated care pool)-a fund that was supposed to be shrinking under the landmark health reform law. The Trust fund remains  over $400 million a year, and the budget includes a $30 million transfer from the General Fund. This is heading in the wrong direction.

Allow the Medical Security Trust Fund to Run a Deficit

The trust pays for health insurance coverage for individuals with incomes less than 400% of the federal poverty line on unemployment. Funding for the Trust has never kept pace with inflation, and money has been taken out for other purposes.  Because the duration of time individuals can collect unemployment benefits has been extended, and employer contributions are insufficient to meet this demand and persistent unemployment high, this portion of the state’s health care safety net is on the brink.

This has been crossposted on Pioneer’s blog: http://www.pioneerinstitute.org/blog/

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Filed Under: User Tagged With: budget, deval-patrick, health-care, healthcare

Comments

  1. johnk says

    January 28, 2011 at 2:12 pm

    Masshealth can change eligibility, they just can’t make it more restrictive and drop people from coverage until the Affordable Care Act comes into effect in 2014. Ooops, is that what you mean?  You want MA to drop people from health coverage???  Wow, what a novel idea. How does that jibe with the state’s health care law?  Doesn’t make much sense since we are working toward coverage for all, does it.  But with your “facts”, oh wait, you don’t have any just Rick Perry and a bunch of Republican governors signing a letter as a tactic to try to weaken the Affordable Care Act as proof.

    <

    p>BTW, you need to drop the Obamacare, kind of makes you sound like an idiot (just trying to help). FYI, I personally think you are a sharp person, so no insult indented.

    <

    p>Your welcome.

    • johnk says

      January 28, 2011 at 2:56 pm

    • josh_pioneer says

      January 31, 2011 at 2:06 pm

      Thanks for the comment.
      Not sure where you got that I was advocating for dropping people from coverage. In fact I wrote “It is time the Governor and his staff seriously consider a global waiver application for Medicaid, following in Rhode Island’s footsteps.”

      <

      p>Rhode Island is on pace to spent billions less on Medicaid this year– without anyone being dropped from coverage, and very high patient satisfaction.

      <

      p>You are right that I was only telling half the truth on the letter from a majority of Governors on Medicaid, there is a second letter from the NGA that came from 47 Governors (R and D) that stated:

      <

      p>”Congress should also modify (the stimulus’) existing maintenance of effort (MOE) provisions. Restoring flexibility to manage our Medicaid programs and enact common sense reforms is critical to ensuring the program’s ongoing and future stability.”

      <

      p>Josh

      • johnk says

        January 31, 2011 at 3:47 pm

        Governors lobbying for additional FMAP dollars a year ago, here’s the letter you are quoting from:

        <

        p>

        Dear Madam Speaker, Mr. Boehner, Senator Reid and Senator McConnell:

        On behalf of the nation’s governors we write to request your assistance in protecting jobs and speeding economic recovery by extending the American Recovery and Reinvestment Act’s (ARRA) enhanced federal match for Medicaid (FMAP) for two additional quarters.

        Unfortunately, the length and depth of the recession means states and territories will continue to face significant budget shortfalls long after the enhanced FMAP provisions expire at the end of this calendar year.

        States and territories are in the process of finalizing budgets for FY 2011 that our legislatures will be considering over the next several months. Timely passage of an extension of ARRA’s enhanced FMAP would greatly assist us in maintaining services and further stabilizing the economy.

        To maximize the positive impact of FMAP enhancements on the economy, Congress should also modify ARRA’s existing maintenance of effort (MOE) provisions. Restoring flexibility to manage our Medicaid programs and enact common sense reforms is critical to ensuring the program’s ongoing and future stability.

        Governors appreciated the inclusion of enhanced FMAP provisions in ARRA. We are committed to encouraging job creation and speeding recovery and urge you to work with us by extending FMAP enhancements and restoring state flexibility over Medicaid as soon as possible.

        <

        p>The NGA’s lobby of reducing MOE is not a health care issue as you frame it, Governor’s generally don’t like strings attached to federal funding, the NGA’s position is similar with education, and everything else that has MOE.

        <

        p>As for RI’s global waiver, gutting services is not the answer.  That is basically what is happening in RI.  With each passing budget Medicaid is cutting dollars to providers as you note above in MA and cutting services.

        <

        p>Well, at least you didn’t note Obamacare this time, we are making progress.  You also mixed in ARRA and the Affordable Care Act together in your notes, they are two different things.

        • josh_pioneer says

          February 2, 2011 at 1:19 pm

          Medicaid is health care spending no matter how you “frame it,” from a state budget perspective. (Strings or no strings )

          <

          p>No matter the motivation behind the letter– it discussed MOE for Medicaid. I did not misrepresent that.
          So where is your argument with what I wrote? That I did not include that they wanted more money?
          Going along with your rationale, Governors should always want two things: no strings and more money. No sure how that changes anything.

          <

          p>Doesn’t matter if they are arguing for a different financing method, more money, or even less money –MOE is MOE and it directly impacts state budgets. The letter shows wide agreement that the top-down, cookie cutter approach that we currently use for Medicaid does not work for states. Do you disagree?

          <

          p>Not sure where the confusion comes with ARRA and ACA (popularly referred to as Obamacare)– they both contained MOE provisions for Medicaid.

          <

          p>While we are still watching the experiment play out in RI, I am not sure you can find a “gutting” of services. In fact, early reports out of the state show many individuals, especially those in long-term care situations are getting considerably better service than before the waiver, and the state and feds are saving money. Is that a problem? Should we just keep cutting payments to make our budget? Will this result in better health care for those most in need?

          <

          p>Josh

  2. johnk says

    February 2, 2011 at 2:23 pm

    and used straightforward facts, not twist items to better suit your argument. That’s all I’m saying.  if you want to have an honest discussion then frame it honestly.

    <

    p>Here is the list of MOE that the association identified, (AKA all of them).

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