Comments on: POLICY: Medicaid as the route to universal insurance?

By: California Health Insurance

California Health Insurance — Sat, 05 Nov 2005 01:21:45 +0000

It would be great to use medicaid as a route to universal health insurance. Health insurance is a major aspect to many and I would like to see everyone covered.

By: Matthew Holt

Matthew Holt — Sat, 13 Aug 2005 01:30:13 +0000

To be fair to Ron, we did have a session about making his posts HSA free a while back, and the consensus was to let Ron keep on being Ron!

By: Ron Greiner

Ron Greiner — Fri, 12 Aug 2005 10:29:14 +0000

Abby,
Are you saying that I should stop saying that Group Health Employee Plans terminate sick employees if they get too sick to work 30 hours per week?
HSA-free zone huh? You’re a hoot.

By: Abby

Abby — Thu, 11 Aug 2005 22:51:09 +0000

What Mitt Romney advocates is barely relevant to the debate in Massachusetts. There’s a veto-proof Democratic majority in both houses, and it looks like Romney won’t be running for re-election. He hasn’t officially announced anything yet, but he did write an op-ed saying that he thought that Roe v. Wade should go and abortion policy should be returned to the states. Hardly a popular position in Massachusetts.
I haven’t heard much from Romney advocating for Medicaid expansion. His current thing is to require people to buy stripped-down policies.
There is a coalition of groups called MassAct which is trying to expand MassHealth considerably. They are hoping to get the legislature to act, but they are organizing behind a ballot initiative. There are 4 proposals on the table.
Their goals are
*Expanded coverage for low-income individuals and families through MassHealth.
*Providing assistance to middle income, working individuals and families to purchase insurance.
*Offering assistance to small businesses to help them pay the premiums for their employees.
*Requiring employers to either provide health coverage or pay a fee to the state.
*Creating a new state quality/cost leadership council
The pay or play thing could be challenged under ERISA, but they are structuring it as a rebate for spending on healthcare, and businesses with annual payroll less than $50K are exempt.
There is some talk of cutting the free care pool assesment on suburban hospitals to get them behind it. They also want to raise the reimbursement rates. The thinking is that the private patients are covering the cost of current MassHealth patients, and that this is driving up the private insurance rates forcing more people into uninsurance.
The executive director of HealthCare For All, the lobbying group behind the effort, has his own blog, Healthy Blog which is worth checking out. Their ACT page has links to other reform efforts.
http://www.hcfama.org/blog/
http://www.hcfama.org/act/index.asp
They plan to pay for this through the employer assesment and by raising the cigarette tax.
Ron,
Can we stipulate that both cancer and depression are deadly, and therefore a fortiori, cancer and depression are a deadly mix. The Health Care Blog doesn’t need to be an HSA-free zone or anything, but please drop that particular line.

By: Ron Greiner

Ron Greiner — Thu, 11 Aug 2005 17:12:23 +0000

Matthew, I said give the poor the amount of their deductible in their HSA. It’s still a lot cheaper than paying for over-priced dangerous Medicaid to politically connected insurance companies.

By: Ron Greiner

Ron Greiner — Thu, 11 Aug 2005 17:07:09 +0000

Very good Eric. Some want to eliminate the tax deduction for job based insurance. I don’t think that will happen and there really is no need. If we give individual health insurance consumers the right to deduct their insurance, the group employee health plans will fold anyway.
Liberals see no need for individuals to be able to deduct the cost of their insurance. Liberals always support Group Health Plans.
HRAs are ok if you want your balance stolen at retirement. HSAs are much better because, 1) you get tax free interest, 2) you keep the money for retirtement healthcare expenses. Always remember, HSA funds that are never taxed will last longer in retirement.
My son just took his insurance test in Nebraska. During his state approved training they predicted 40 million HSAs in America.
President Bush said, “Hopefully, when I’m an old guy my HSA will be bulging with money.”

By: Matthew Holt

Matthew Holt — Thu, 11 Aug 2005 17:05:57 +0000

Wow, we’re busy today — 2 posts while I was writing mine. Eric — I am very suspicious of that “premiums down 15%” number from eHealthinsurance, as they dont state the other parts of the equation, that is, what’s the average deductible people are getting and how aggressive is the medical underwriting on those plans becoming. I am trying to get them to answer…

By: Eric Novack

Eric Novack — Thu, 11 Aug 2005 17:03:08 +0000

Spike- you are right in the current environment (we must have posted simultaneously) that- all things being equal, not much will be saved (if any). The essential piece that is implicit in the HSA promoters’ plans- though rarely articulated– is the concept of personal responsibility and ownership over one’s own healthcare.
To wit– one specific example and one general example:
#1: 40 year old man plays basketball with his child on Sunday- on Monday knee is somewhat swollen and sore. Goes to orthopedist on Thursday. Doctor is suspicious for a “cartilage tear”. Fact- many with cartilage tears do better than fine with just time and an exercise program. In the current HMO environment– the $10 copay covers it all– so the patient says “I really want the MRI now to know if its torn, because I have a vacation coming up and want to be able to hike”. In the HSA world– the patient knows that it is his $700 that will be spent on the MRI– so perhaps he takes the very reasonable advice that he should modify activities and then begin a specific exercise program over the next 4-6 weeks to see if he improves. This is where the savings occur.
#2: Diabetes and heart disease are- by far- the two most expensive diagnoses (cost to healthcare system)– if people understand that their health and their healthcare dollars belong to them– hopefully we can begin to instill in the public the unbelievable cost savings to themselves- both dollars and quality of life- that healthy living can have on these conditions (which may or may not be completely of their choosing).

By: Matthew Holt

Matthew Holt — Thu, 11 Aug 2005 16:56:03 +0000

Ron, I’ve missed you!
Spike & Tom, Ron is kind of a one note tuba on the HSA issue…no one from the high deductible plan side has successfully answered the question about where does the money come from to pay for care for the sick if everyone only has a high deductible plan (i.e. the 80/20 rule)….but I may have another response to that if I can con Eric into doing some work….
However, I agree with Ron (mostly) about what a mess Medicaid is, and I don'[t believe in expanding Medicaid as is to all (which appears to be what the Repubs interviewed by USA Today are advocating). What I do believe in is creating a universal insurance pool (but whatever means we come up with) and putting Medicaid recipients into it with essentially everyone else.

By: Ron Greiner

Ron Greiner — Thu, 11 Aug 2005 16:54:29 +0000

Spike, after the deductible the HSA insurance pays 100%, including drugs. Now Medicaid is charging co-pays so it’s cheaper for the poor. Plus, Medicaid is very dangerous. If you are on Medicaid and get diagnosed they terminate you if you start making a dollar. With individual insurance the poor can’t be terminated because they find some employment. That is much safer spike. Same with SCHIP for children. If a child become diagnosed they are terminated on their 19th birthday. Come on spike, terminating a young girl with no hair because of cancer, just because they reached their 19th birthday is depressing. We all know depression and cancer is a deadly mix.
Spike jump on board Republican healthcare reform so the poor will have the security of individual insurance purchased in the free and open market. Sure the big insurance companies with government contracts will be a bit upset, but who really cares.
Besides a healthy child, like most children, would show up on their 19th birthday with a big fat HSA balance, all tax free. Now that would be a caring Nation for the Country’s poor children.