I recently read a comment on social media from a doctor equating accepting Medicare and Medicaid to (a doctor) signing her slavery agreement. And as insulting and inaccurate (slaves didn't sign agreements!) as this statement is, the sentiment is not too far off from what many doctors in America share. Doctors often refer to Medicaid as charity work.
The claim that Medicaid reimbursements do not cover the cost of care is near universal. Some specialists claim they make about $8/hr. treating Medicaid enrollees. Others publish a sampling of their Medicaid reimbursement payments online to show Medicaid paying less than $5 for care billed at $400. Of course, they never share all of the information about a claim, just enough to "prove" their narrative of poverty inducing Medicaid rates.
Meanwhile, physician complaints about Medicaid are the same as the ones they have about private insurance; they just hate Medicaid (and Medicare) more because of the lower reimbursement rates. For all payers, doctors complain about jumping through hoops to get paid, late payments, paperwork, and regulations. Some doctors have also complained about the behavior of Medicaid patients (don't exactly know what they mean by that).
Unfortunately, doctors and hospitals can get away with their Medicaid-rates-are-too-low claims because they are the ones setting the rates. And, as we know, they charge different rates for different groups of patients—Medicare, Medicaid, patients with private health insurance, patients without private health insurance, etc. But these rates aren't related to actual costs because a doctor's time and effort are never measured. So doctors cannot prove Medicaid rates don't cover the cost of their services. Still, that doesn't stop them from demonizing Medicaid, but the reality is that doctors don't like any program or law that controls the fees they can charge or requires them to meet certain standards.
Brief Primer On Medicaid Reimbursement Rates Continue Reading...
Decades ago Dr. Martin Luther King, Jr., spoke about the triple evils in society—poverty, racism and militarism. These three things still exist and continue to feed off of one another, but this week three more evils emerged. Speaker of the House of Representatives, Paul Ryan; Secretary of Health And Human Services (HHS), Tom Price; and Director of the Office of Management And Budget (OMB), Mick Mulvaney recently embarked on a tour to spread Step One of their evil health care plan. Shameless lying about an Obamacare death spiral is to be expected from these three, but the callous response to their health care bill's impact on the elderly and poor is shocking.
With a little preparation, Ryan, Price and Mulvaney hit the media circuit and boy did their true colors shine through. Ryan continued in his persona of the cocky politician staying true to his conservative principles. Price adopted the role of the all-knowing physician giving the uniformed a hard dose of medicine on the evils of government "interference" in health care. And Mulvaney, serving as Trump's representative, is just hard to watch.
The one and only good thing about the introduction of the American Health Care Act (AHCA), is that it totally destroyed Paul Ryan's (fabricated) reputation as a brilliant policy wonk. Ryan's contribution to the AHCA is ideological and administrative. Ideologically, Ryan does not believe in taxing rich people and does not like entitlement programs. Consequently, questions about the tax cut for the wealthy and the gutting of Medicaid elicit smirks and God-awful responses from Ryan, including these gems from his interviews with radio host, Hugh Hewitt and Fox News' Tucker Carlson, respectively:
“But we always know, you’re never going to win a coverage beauty contest when it’s free market versus government mandates.” Ryan's response is reminiscent of remarks made by former Louisiana Governor, Bobby Jindal, when he rolled out his Obamacare repeal plan:
"whatever amounts of money conservatives were willing to allocate to address a problem, Democrats would always be willing to spend more, so conservatives cannot get into a bidding war." And, “I think it's a mistake if we measure health care reform in terms of how many people we give cards to.”
But Ryan wasn't done being a jerk, this is what he said when called out by Carlson for eliminating an investment income tax on the richest Americans as part of his reform reconciliation bill, "I'm not that concerned about it because we said we were going to repeal all of the Obamacare taxes and this was one of the Obamacare taxes."
And concerning millions of people potentially losing Medicaid coverage, Ryan has expressed absolute giddiness about the billions of dollars in federal savings and the prospect of de-federalizing Medicaid once and for all.
With Paul Ryan, you get an ideology without a soul.
Tom Price, Preserver of the Doctor-Patient Relationship And Access Proponent Continue Reading...
How bad the American Health Care Act (AHCA), the Republican replacement for the Affordable Care Act (aka, Obamacare), will be for the mentally ill, women, poor people, children, older people, and people needing drug treatment is still unknown. However, everyone expects these groups to receive less financial support in purchasing health insurance and in accessing health care. Meanwhile, the young, healthy and the wealthy have something to smile about if the AHCA becomes law.
But According to Donald Trump, weakening Medicaid and providing skimpier subsidies than Obamacare is
Don’t Underestimate The Republicans Capacity For Cruelty
After rolling out step one of the American Health Care Act, Republicans in Congress proceeded to make some of the dumbest and most hypocritical remarks in political history. I'm being dramatic but I'm not the only one that attacked Congressman Jason Chaffetz's on Twitter for his dumb iPhone remark, or who was disgusted by Senator Tim Scott's dissing of the Congressional Budget Office (CBO) because he suspects it will reveal the bill as a huge takeaway for the millions who got insurance under Obamacare. And let's just try and forget Paul Ryan's misleading, inaccurate and amateurish PowerPoint presentation where he revealed that he doesn't know the definition of insurance, and his performance on Fox News where he coldly stated that he didn't care about the windfall his bill gives to the rich. Continue Reading...
Everyone wants to see the Paul Ryan/Tom Price Affordable Care Act (aka Obamacare) replacement bill, even most Republican lawmakers. But Ryan and Price would rather look like a putz than reveal who will be the primary losers under their new plan. They are also afraid that their fellow Republicans will join the media in ripping their plan apart. They have no desire to be once again the objects of a mocking press, Democrats and Obamacare supporters for their inability to present a Republican, majority-supported Obamacare alternative plan.
After embarrassing leaks describing their reform paralysis at the Republican retreat in Philadelphia earlier this year, and the leaked draft that revealed a proposal to base tax credits on age instead of income, Ryan and Price literally went underground (House basement) to reveal their latest proposal to a select group of lawmakers. There's plenty to mock about this childish approach to drafting legislation. But like all things related to Republican health care reform efforts, this latest hide and seek stunt is about politics and not providing affordable health care. Ryan can't keep putting out bad proposals that the rest of the GOP won't support. At least not publicly. He failed in his promise from years ago to lead the effort to draft an Obamacare replacement bill and is now just a mere figurehead of the process. Health care reform is now a Senate and White House effort with Ryan serving as secretary and spokesperson.
And with Senator Mitch McConnell and Secretary Tom Price leading the effort, we can expect more drastic cuts to federal subsidies and fewer people with insurance coverage than if Ryan had pushed through all of his lackluster reform ideas. McConnell has always wanted to push health care reform back to the states via high-risk pools and other disproved policies. But states have made it clear that they need federal government funds and they like the money Obamacare provided. Therefore, I expect the new Republican health care reform bill to grandfather Medicaid expansion for the states that adopted it. And based on past Ryan/Price proposals and the Trump Joint Congressional speech this week, we can easily assume that the crux of the law includes health savings accounts and tax credits that will mostly benefit the well-off, healthy and young