Category Archives: Medicaid

Despite expanded coverage, hospitals may see more bad debt – Nashville Business Journal

I definitely don’t want to harsh on anyone’s mellow about Obamacare, but this is the part that worries me:  the bad debt that hospitals are going to take on.  This issue is going to have to be reconciled somehow.

Despite expanded coverage, hospitals may see more bad debt – Nashville Business Journal.

ODI: Health insurance premiums to increase 41 percent |

Then again, maybe not.

ODI: Health insurance premiums to increase 41 percent |

More people covered, costs lower for Washington Health Plan – – Aug. 2, 2013

Obamacare — it’s working!

More people covered, costs lower for Washington Health Plan – – Aug. 2, 2013.

Mississippi GOP Leaders Say They Will Resist Expanding Health Care

In case you wonder what Obamacare will look like in some states, here is an example of a state, Mississippi, that is already saying “Whoa, horsie!” when it comes to implementation.

Miss. Medicaid expansion unlikely, GOP leaders say – The Dispatch.

I wonder about the implementation here in Rhode Island and whether we will be able to extend health care coverage to all, given our sagging economy. As I said in an earlier post, I see health care as a potential economic driver, and I hope Rhode Island will find ways to make this happen.

As a health care practitioner, I am particularly interested in changes specific to children and families. For more on how the law specifically impacts children and families, the Children’s Mental Health Network has a page that gives a helpful breakdown of all the changes.

[Ninjanurse butts in to Kiersten's post]
Lt. Governor Elizabeth Roberts sent an email with this–

Rhode Island has been implementing the federal health reform law for over two years, beginning with Lt. Governor Roberts’ early efforts in 2010 to ensure Rhode Island had a clear path ahead toward achieving universal coverage for Rhode Islanders. With the Supreme Court’s ruling, that path has been cleared for the state to move forward in partnership with the federal government and continue to benefit from its support and funding.

The Supreme Court decision means up to 120,000 uninsured Rhode Islanders will be able to enroll in healthcare coverage starting October 1, 2013 and will have access to the coverage by January 1, 2014. Rhode Island families and small businesses soon will have an online marketplace known as the RI Health Benefits Exchange where they can easily buy and compare health insurance options. Some residents will even qualify for free or low-cost insurance depending on their income. Rhode Islanders will begin to hear more about this marketplace in the coming months.

These are not empty words, but a work in progress. As much as I wish we could speed it up, I know that good people are working overtime to meet these goals.

One of those good people is a Republican, Christine Ferguson, who has been appointed by Governor Chafee as head of the new Rhode Island health insurance exchange. Ms. Ferguson has a long resume of health management experience in Rhode Island and Massachusetts and is a passionate and effective advocate for people in need of access to basic healthcare. We’re lucky to have her on our team at this point in time.

My Conscience Clause

I’m thinking about how my tax dollars are going to buy proton pump inhibitors for people who not only don’t have ulcers, don’t have raging gastric reflux– but people who tell me their stomachs are just fine!

I’m outraged. My religion, which I re-name weekly, forbids over-prescription of drugs of dubious benefit to people who don’t actually have a disease. My philosophy is called ‘evidence based’. It’s a minority religion, I’ll admit, but reality does have a way of sticking around whether it fits our narrative or not.

I demand that insurance companies stop funding proton-pump inhibitors for people who would do just fine with an occasional Tums. I demand that the secular authorities bow down to my authority as High Priestess (self-ordained) and re-arrange everyone’s insurance immediately.

Don’t whine to me that your stomach hurts. I have conscience, and I’m exercising it on you.

Toxic Debt Ceiling Collapses on US Elderly

AARP released a statement about the newly passed legislation on the debt ceiling. While in the first two paragraphs, it’s clear they are trying to be nice, by the third paragraph, they are getting down to business about what is wrong with this legislation. From the statement:

“We are relieved that Congress has acted on a bipartisan agreement to address the debt ceiling and prevent default to ensure that seniors will continue to receive their Social Security checks and have access to health care. We are also gratified that after hearing from millions of AARP members, the President and Congress did not cut Social Security, Medicare and long-term care in the first round of deficit reduction.

“Going forward, we are pleased that Social Security, Medicaid and Medicare benefits are protected if the so-called “super committee” fails to reach an agreement later this fall, but we will remain vigilant in our efforts to protect the health and retirement security of seniors and future retirees. We are concerned that a fast-track committee process will deny Americans a voice in the discussion about critical tax, health and retirement issues. We also are concerned about the potential use of a trigger that would arbitrarily cut provider payments under Medicare, which could unfairly shift costs to seniors.

“Seniors have worked their entire lives to achieve a level of health and economic security in retirement. As the deficit debate continues, AARP will continue to impress upon Congress the need to protect Medicare and Social Security from harmful cuts. With the compounded effect of loss of retirement savings and home equity, high unemployment and rising health care costs, cuts to the benefits seniors have earned could undermine the standard of living of not just those with limited incomes, but middle class seniors who have median incomes of only $18,500.

“AARP will continue to raise the voices of millions of Americans who rely on their Social Security and Medicare benefits and oppose benefit cuts for deficit reduction. Americans want a broader conversation around health and economic security, not one focused solely on deficit reduction.

“AARP believes that the American public deserves a seat at the table in any forum, including the newly created super committee, that discusses potential changes to these critical programs. We believe that our nation’s leaders should work together to strengthen health and retirement security for current and future generations.”

Who is going to be on this “Super Committee”? Is this “Super Committee” going to supplant Congress? How many seats on the Super Committee are going to be reserved for the already-super-influential corporations?

Great News for RICLAPP and Upcoming Event with Elizabeth Roberts

Great news for the Rhode Island Center for Law and Public Policy — they have received a $2,000 grant from the City of Cranston to support their legal services clinics at the Cranston Senior Center. RICLAPP is also holding an event on accessing medicaid with panelists including Elizabeth Roberts and Warwick Mayor Scott Avedisian:

Are You Or A Loved One Confused About the Medicaid System?

Come Gather Useful Information and Have Your Questions Answered at the Senior Seminar

Understanding Medicaid and the New Global Waiver

Date: April 14, 2010

Time: 12:30 – 2:30

Place: Pilgrim Senior Center

27 Pilgrim Parkway

Warwick, RI 02888

Panel of Experts:

Elizabeth Roberts, Lieutenant Governor

Scott Avedisian, Mayor of Warwick

Corinne Calise Russo, Director of the RI Department of Elderly Affairs

Kathleen Connell, State Director of AARP

Light Refreshments Will Be Served

It’s nice to be part of an organization that is having so much success at bringing important events to the community. I hope you will join us on April 14th for the event at the Pilgrim Senior Center.

Prayer Against Stupidity

Quick post before I face our health care ‘system’ once again, thank goodness as a worker in it, not a person lost in the Bardo of insurance battles.

While driving to see patients, I heard some of President Obama’s speech to doctors on WRNI. Doctors used the word ‘stupid’ more than once describing the things they have to do to navigate insurance and liability and paperwork that can only multiply, because that’s what happens when you hire people to multiply the paperwork. But now we’ve got computers so we can multiply time spent on data entry–save a tree, buy stronger glasses and wrist braces.

Today I offer this prayer from the Tibetan Book of the Dead, for all those who have died of stupidity—

When, through intense stupidity one is wandering in samsara,
Along the bright light path of the wisdom of reality,
May the Bhagavan Vairochana lead us
May the Mother of Great Space be our protector
May we be liberated from the fearful narrow passage of the Bardo, May we be placed in the state of perfect enlightenment.

Also, I’ve pulled out an oldie but goodie, a post called Her Skull Was in the Freezer. True story–a medical miracle and the insurance stupidity that almost undid the patient.

The Lowdown on the Governor’s Budget

Being in the middle of starting my own private practice office here in Cranston, I have not had much time lately to devote to blogging. Therefore, I am honored to have a guest blog post on Governor Carcieri’s budget from Carville, a frequent commenter here on Kmareka and a thoughtful analyst of Rhode Island social and economic issues. From Carville:

I would like to thank Kmareka for allowing me to post on this issue. On January 7, the Governor took the unprecedented (for him) step of addressing Rhode Islander’s regarding the economic crisis the state faces and his proposals to resolve, or at least mitigate, that crisis.

Below are links to the Governor’s Supplemental Budget legislation and video of his speech (in case you didn’t see it).

Governor Supplemental Budget

Video of the Governor’s Speech

Here’s my take. Call it my dirty dozen.

First, in the abstract, a statewide health plan for public school employees might be a good idea. At the very least, it takes the health issue off negotiating tables and may stabilize costs. However, this plan isn’t in the abstract. According to the Governor’s bill, health care is no longer a subject of collective bargaining. Instead, a Healthcare Advisory Council  will determine provider, coverage and rates, with the employee’s co-share set at a minimum of 25% of premium. Under the provisions contained in this bill, savings won’t come from a superior negotiating position. Rather, savings will come from gutting the coverage and unilaterally increasing co-shares.

Second, the creation of the “Rhode Island School Realignment Commission” could be (stress could be) meritorious. However, this is not a plan thought out on its merits, but out of financial “necessity”. The driver’s all wrong and the timing couldn’t be worse. It’s not the most prudent approach to raise the specter of sweeping educational changes without laying a proper foundation. This new five-member Commission will be charged with developing plans and legislation for a mandatory vote by the General Assembly. As always, the devil is in the details.

I hope someone in the Governor’s administration was paying attention in the late ’60s when regionalization was first proposed. If the “realignment” is broken down by county as he indicated in his speech, there could be a problem. That was the prescription of the old Thibeault Report (Education in Rhode Island: A Plan for the Future – June 1968), which went nowhere. Why? Politics and money. The local politics was and remains that no municipality wants to lose local power over schools. It’s a New England thing I guess. The money issue is who pays, where does locally raised tax money go, and what kid goes to which school? Added to that, in the combination of services (from Administration through clerical and purchasing) who wins and who loses? This is a zero sum game no matter how it’s cut. Finally, the member of the Cranston delegation who would support a regionalization plan combining Cranston with Providence on a county regionalization basis is already on political life-support.

In short, these collaborative/regionalization proposals sound good and are proposed to please the masses. However, in the end, it’s all smoke and mirrors with no chance of success without real leadership from the Executive branch. And when was the last time you saw that?

Third, the Governor proposes to balance the budget partially on the backs of the Station survivors and families. I can’t decide if this is more tragic than obscene or vice-versa. Oh yeah. This is a one-time deferral — until the next time, which will probably be next year.

Fourth, the Governor’s supplemental already contains a $ 27 million deficit on the anticipated Medicaid payments from the Fed. The Congress has to vote on that and then the allocation needs to be made. Any bets on how correct that projection is? Remember, $ 67 million of the current deficit is related to not realizing the “savings” accrued from the Medicaid Global Waiver/Death Star because his administration dithered with the application.

Fifth, based on prior reporting, the state executive offices, including the Governor’s office, are bleeding money. Surprised there was no mention of that or a recognition that everyone is to blame — including the Governor and his crack management staff.

A Kmareka Pop Quiz: Who was the only state officer who not only didn’t have his budget cut in the Supplemental, but gained additional money?

Sixth, while touting the fact of no “broad-based” tax increase, he conveniently didn’t mention, or if he did he ran by it quickly, the increase in registry fees that many of us will pay. This will have a greater impact on lower-income people than those who live in the Governor’s neighborhood. Fees tend to be regressive like that.

Seventh, I don’t smoke, so the extra buck a pack doesn’t bother me. But, again this tax falls more heavily on the poor than others. But, hey, we’re still cheaper than Massachusetts. I know that it’s a “personal choice” to smoke and people who do (just like those unwed teen mothers the Governor spoke about a couple of months ago) make “bad choices.” So, is any of this money going to smoking cessation programs? No. Why not? Because it’s now public tax policy to keep people smoking so that we can collect an extra buck a pack.

Also, if you are a small business owner selling cigarettes, your inventory tax is going to increase as well.

Eighth, the reduction of aid to cities/towns. Again, a bomb in the middle of their budgets and not a thought-out plan for reform. In effect, he did what the Daily News headlined when Ford was President — Ford to NYC: Drop Dead. Do the contracts need reform? Sure. But it must be done in an orderly process as part of a longer-term reform effort, not like some Laffey-like gunslinger shooting up the towns (and cities).

As an aside, since this impacts education, I recall the Governor stating that his Supplemental reduced aid to cities and towns by 6%. In fact, it’s 9% in aid to education. This from someone who once wanted to be known as the “Education Governor.”

Ninth, related to eighth, the whole pension argument is sheer sophistry. The shift away from a defined benefit to a defined contribution pension plan is horrible. Don’t think so? Look at your 401(k) and see what you’ve lost. And linking his proposals as equal to the best in the private sector is ridiculous. The private sector just isn’t that good anymore – period. That’s even assuming that there’s any pension plans left as many corporations took the money previously dedicated to those plans and plowed them into stock dividends and CEO bonuses/golden parachutes. In short, like Bush, the Governor’s trying to privatize what used to be a public good.

Tenth, he set up a “straw man” toward the end by claiming that some want tax increases. Then he heroically opposed any mention of “broad-based tax increases” or an increase in the sales tax and corporation taxes. With this sleight-of-hand, he removes from the discussion the tax breaks for high-income earners passed in 2006 along with reductions in capital gains taxes. These breaks have cost the state millions and have no doubt contributed to the current mess we’re in. I’m not a “soak the rich” person, but we should all share the burden and we’re not. Not only does his position make no sense economically (in that there’s no return on these tax expenditures) but it is fundamentally unfair to have some people, many of whom are already struggling, carry the burden for those who could more easily contribute to the solution. This policy of cutting taxes indiscriminately to grow the economy is just like A Field of Dreams – it’s fiction. Targeted tax cuts based on an economic model forecasting returns on that investment are appropriate and even desirable. But this shotgun approach to lower taxes is economic and ideological blather. It hasn’t worked on the federal level and it’s not going to work at the state-level no matter how much the Governor beats that drum.

Eleventh, he could have done something with corporate taxes that wouldn’t have any impact on the small “mom and pop” corporations that pay the minimum tax each year. For example, if he even considered fundamental fairness at all, he could have proposed legislation for “combined reporting”, which would require multi-state corporations to determine their tax liability in the state. As of 2007, 20 of our sister states (including New York) have a combined reporting requirement. And in 2007, even that paragon of virtue to our north, Massachusetts, was considering such a plan. There’s no reason why we should let The Gap make a ton of money in Rhode Island and get away scot-free or tax free. Burdens should be shared equally.

Twelfth, Rhode Island’s vaunted “safety net.” In his speech, the Governor omitted Article 30 of the Supplemental. This Article would omit any family or child from medical assistance if the combined value of child’s and/or family’s liquid resources exceeds $ 10,000. Indiscriminately and unilaterally, we’re kicking those folk off because they have (gasp!) a bank account So, let’s see if I’ve got this new theory of a “safety net” down. You get laid-off from your job (not an unusual occurrence given figures released by the state), have little to no money coming in, can’t make the mortgage payments so you’re likely over time to be foreclosed on (thus rendered homeless) and now you lose health insurance because you have modest “liquid” assets? Too bad, you lose! Would that the working citizens of Rhode Island had the same “safety net” as corporations and those high-income citizens that are protected by this administration.

Finally, again regarding the “safety net” that the Governor so vigilantly guards, I give you the new Medicaid Global Waiver. Like so many proposals coming from the Governor, this waiver is driven by the bottom line and not by a desire to deliver better services to people in need. While he may argue that he won’t deny anyone in need of assistance, the Governor and his staff should go back and read the plan’s application. The application for the Global Waiver specifically states that all but those most critically in need (defined as those who, under the new plan, will require nursing home placement) will receive assistance and services if funds are available. That’s not exactly the iron-clad guarantee of services that the Governor made in his speech.

In the end, the Governor’s speech was vintage stuff. Bash public employees, use tax policy as a wedge issue between taxpayers and public servants, raise broad-based “fees”, weaken the safety net, and protect the rich and powerful on some quaint notion of tax policy and free market capitalism that would probably make Adam Smith puke (sorry for the J.D. Salinger allusion).

Instead of a plan, the Governor offered an anti-government screed. This week, when real leadership was needed, the Governor came up pretty small.

Thank you, Carville, for bringing up all of these important issues about the Governor’s budget. The months ahead give us the opportunity to address the problems with this budget and hopefully work out some successful solutions.

Kmareka on TV

Ninjanurse (aka Nancy Green) is a guest on the public access program, ‘Rhode Island Soapbox’. The panel debates “Aging in Community’ The moderator is Judy Newcomb-Gross, other guests are Dick Bidwell of the Grey Panthers and William Flynn, executive director of Senior Agenda Coalition of RI. Our gracious producer is Libby Schiller.

We talk about the impact on the elderly of the Governor’s proposed Medicaid global waiver. Rhode Island lags behind most of the country in making funds available for home care. Most of our money is going to nursing homes. There’s potential for reform here, and some questions. Medicaid is the safety net for children, young people and people with disabilities, as well as the elderly. The Governor promises that no benefits would be cut, but I’m not alone in being skeptical. Parents of disabled children were testifying at the State House this week.

I’m hoping our legislature won’t be rushed into approving the waiver before they ensure that all the people who depend on Medicaid will continue to be protected. You can see us on Rhode Island Soapbox–

Cox Channel 18 in Pawtucket
Thursday January 15 at 6pm
Friday January 16 at 6pm
Statewide Interconnect, Channel 13
Saturday, January 24 and 31, February 7 and 14 at 2pm


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