Georgia Chapter, American Academy of Pediatrics: 2012

Growth in employees' health insurance premium costs outpaced growth in income in all 50 states from 2003 to 2011, while deductibles nearlydoubled during that period, according to a new report released by the Commonwealth Fund, Modern Healthcare reports.

The report, which aimed to better understand the financial strain on households and business budgets from the nation's rising health care costs, found that:

A worker spent an average of $3,962 on premiums for employer-based family health coverage in 2011, an increase of 74% from 2003;
The average premium for a family plan in 2011 was $15,022, up 62% from 2003;
Seventy-eight percent of insured workers had deductibles in 2011, compared with 52% in 2003;
The average deductible for an individual health plan in 2011 was $1,123, an increase of 117% from 2003; and
The average deductible for a family plan in 2011 was $2,220, an increase of 106% from 2003 (Evans, Modern Healthcare, 12/12).

Premiums increased three times faster than incomes for workers in New Mexico, South Carolina and West Virginia, where the premiums exceeded 25% of median wages, the report found.

The report warns that average family premium rates could reach $25,000 by 2020 if premiums continue to climb at the current rate.

ACA Provisions' Effect on Costs

Cathy Schoen -- senior vice president for policy, research and evaluation at the Commonwealth Fund, and an author of the report -- credited mechanisms in the ACA that have "begun to lay the groundwork to address costs and provide a platform for further action."

The report cited the law's medical-loss ratio regulations, the Medicaid expansion, the creation of health insurance exchanges, rules prohibiting insurers from denying coverage to individuals with pre-existing conditions and new payment incentives as examples of changes that could help lower premiums.

However, Robert Zirkelbach -- a spokesperson for America's Health Insurance Plans -- said that new taxes on insurers and minimum coverage requirements outlined in the ACA could drive up premiums. He added that the MLR provision is forcing insurers to scale back on non-medical coverage-related programs, such as accountable care organizations or health information technology investments.

Schoen acknowledged that efforts to contain health care costs will require action beyond the provisions in the ACA. "We need to take a marketwide approach that examines and focuses on the prices that being charge for care," she said (McGlade, CQ HealthBeat, 12/12).

Childhood Obesity and the Medicaid Squeeze

POSTED BY MARK FUNKHOUSER | DECEMBER 13, 2012 GOVERNING MAGAZINE

As every governor knows, the growth in Medicaid spending is one of the major threats to states' fiscal sustainability. Medicaid currently consumes 24 percent of total states' funds. Spending on the program has grown at an annual average rate of 7.2 percent over the past decade, and that growth rate is projected by the Centers for Medicare and Medicaid Services to increase to 8.1 percent in the current decade. The cost of Medicaid now exceeds that of K-12 education as the largest area of state spending and is beginning to squeeze out other programs.

Getting Medicaid spending under control might seem to be a hopeless goal, but it isn't hopeless at all. The single most effective strategy would be to return childhood obesity rates to their historic levels, and there are encouraging developments in places as diverse as New York City and Mississippi.

That positive news couldn't be coming at a better time. As the Trust for America's Health and the Robert Wood Johnson Foundation have reported, childhood obesity rates have essentially tripled in the past 30 years, from 6.5 percent in 1980 for children ages 6 to 11 to 19.6 percent in 2008. For teens ages 12 to 18, the obesity rate climbed from 5 percent in 1980 to 17 percent in 2010.

The impact of those numbers on health-care costs are clear. Laura Segal, writing on the Trust for America's Health website, reports that being obese puts a person "at increased risk for more than 20 major diseases, including type 2 diabetes and heart disease." Alvin Powell, writing in the Harvard Gazette, notes that diabetes cases essentially have doubled in the last 20 years and that diabetes "is the nation's seventh-leading cause of death and a prime cause of kidney failure, blindness, nontraumatic limb amputations, heart disease, and stroke." Twenty-six million Americans had diabetes in 2010, and direct and indirect costs came to $174 billion, Powell reports.

Poor kids are more likely to be obese and more likely to be on Medicaid, and the incidence of type 2 diabetes among children, which used to be rare, now is on the rise. Moreover, a recent study shows that the disease progresses more rapidly in children than in adults and is harder to treat. "It's frightening how severe this metabolic disease is in children," David M. Nathan, an author of the study and director of the diabetes center at Massachusetts General Hospital, told the New York Times. "It's really got a hold on them, and it's hard to turn around."

So it's encouraging that the rate of increase in childhood obesity has leveled off in recent years and in some jurisdictions is even showing declines. Between the 2006-07 and 2010-11 school years, for example, New York City saw a 5.5 percent decline in the obesity rate among children in grades K-8. Philadelphia not only achieved an overall decline in obesity rates among K-12 students, but also reported the largest declines among African-American males and Hispanic females, two groups with disproportionately higher obesity rates.

Mississippi, which has the highest rate of obesity of any state, showed the greatest percentage decline, according to a recent report by the Robert Wood Johnson Foundation: In the spring of 2005, 43 percent of Mississippi children in grades K-5 were obese. By the spring of 2011, the rate had declined to 37.3 percent, a drop of 13.3 percent. There are likely to be many reasons for this decline, but the Healthy Students Act of 2007, which required Mississippi's public schools to provide more time for physical activity, offer healthier foods and beverages, and develop health-education programs, appears to have played a role.

Governors, mayors and other policy makers who've been looking at programs like first lady Michele Obama's Let's Move! initiative as little more than a feel-good kind of thing ought to give those programs a second look. There isn't any good reason why we couldn't bring childhood obesity back to the where it was in 1980, and doing so would be a lot more effective in reducing Medicaid and other public health-care costs than tinkering with provider rates and eligibility structures.

There are dozens of organizations and efforts focused on this issue, and real progress will probably take an "all-of-the-above" sort of strategy. Once people see the connections and the implications, getting them on board ought be as easy as child's play or as simple as a brisk, invigorating walk in the park.

Friday, December 14, 2012

Governor predicts Medicaid budget challenge at 'Blessing of the Ground' | AccessNorthGa

Thursday, December 13, 2012

Just A Spoonful: Sweet Taste Comforts Babies During Injections

Study Suggests An Inadequate Immune Response In Children With RSV Is Directly Associated With The Severity Of The Disease

Medicaid primary care pay at risk in lame-duck talks - amednews.com

2-Year Period After Parent's Suicide Try Most Risky for Children: Study

Child Abuse in U.S. Declines for 5th Straight Year

Georgia inches up in health rankings

Wednesday, December 12, 2012

Mothers' Pre-Pregnancy Weight Tied to Kids' IQ, Study Says

Commentary: Medicaid expansion needed | Georgia Health News

Health rankings: USA is living longer, but sicker

WebMD to cut 62 jobs in metro Atlanta | www.ajc.com

Governor Nathan Deal warns Georgia legislators there will be no money for new initiatives | jacksonville.com

Congressional Democrats Warn Against Medicaid Cuts

Congressional Democrats Warn Against Medicaid Cuts

By Rebecca Adams, CQ HealthBeat Associate Editor

Some Democratic senators and congressmen said Tuesday that they would not support a budget-reducing deal that cut Medicaid, even as one leading House Democrat acknowledged that the party will probably have to accept Medicare cuts.

“Whatever they’re talking about with Medicare, maybe there are some things we can live with,” Rep. Henry A. Waxman, D-Calif, said at a Capitol Hill event organized by consumer advocacy and union groups such as the Service Employees International Union and Families USA. “But we cannot live with any cuts in Medicaid.”

But when asked about several specific Medicare proposals that are said to be under consideration in the fiscal cliff and beyond talks — including further efforts to charge wealthier seniors more for their coverage, changes to Medigap supplemental insurance, additional cuts to providers and raising the eligibility age of Medicare — Waxman declined to endorse them.

Waxman singled out two significant Medicaid provisions gaining traction as cause for concern. He said that in order to stave off an approximately 27 percent cut in Medicare payments for physicians that is scheduled to hit in January, many Republicans are floating the idea of blocking a temporary Medicaid rate increase for physicians. In 2013 and 2014, primary care physicians are set to receive the same rates for Medicaid patients as Medicare patients. The provision was put in the 2010 health care law to address concerns that Medicare traditionally pays higher rates and primary care doctors will be needed to handle the expected influx of Medicaid patients that will join the system in 2014.

Waxman also criticized the idea of setting a per capita grant for each state participating in Medicaid, a variation on the GOP block grant idea that he said “some in our party” are floating as a way to reduce the costs of the program.

House Republicans would like to cut $600 billion over a decade from Medicare, Medicaid and other health programs.

Other Medicaid reductions that have been suggested include ratcheting down the amount of money that states can draw down in higher federal matching rates through taxes on providers, reduced funding for durable medical equipment like wheelchairs and savings in care for people who are dually eligible for Medicare and Medicaid.

The Obama administration has been amenable to some of those proposals, such as lowered provider taxes, but in recent days it has backed away from some ideas it previously proposed for cutting Medicaid. For instance, President Barack Obama previously had proposed blending the various rates for Medicaid. But on Monday, administration officials said they no longer back that idea.

The three congressmen and six senators at the event repeatedly voiced concern that Medicaid cuts would be exchanged for tax increases on the wealthy, under the logic that if the higher-income taxpayers take a hit, then lower-income should too. But the lawmakers said their key message was “hands off Medicaid.”

“In many cases, our votes are at stake,” said Sen. John D. Rockefeller, IV, D-W.Va.

The lawmakers included several high-ranking members of committees overseeing health issues, including Senate Health, Education, Labor and Pensions Committee Chairman Tom Harkin of Iowa and many of his panel members and House Budget Committee ranking Democrat Chris Van Hollen of Maryland. “Any cut in Medicaid, any cut, will be felt by our most vulnerable,” said Van Hollen.

After the press conference, Waxman said that any changes to Medicaid would indicate to governors who are weighing whether to expand their programs in 2014 that the federal government is not a trustworthy partner. The overhaul law promises that the federal government will pay all the costs in the first three years for newly-eligible people if a state expands its program and even in after that full funding phases out, the match will not go below 90 percent. “If you start changing the Medicaid program this year, then all the governors will say, ‘Well, if they change it now, maybe they’ll change it later.’ So they might want to hold back on moving forward with the Affordable Care Act,” said Waxman. “I think the administration understands the importance of Medicaid as a program to help the most vulnerable and as an essential component for the success of the Affordable Care Act.”

Tuesday, December 11, 2012

Young Binge Eaters Prone to Illicit Drug Use: Study

Junk Food Taxes Pay Off, Study Finds

Program for babies, toddlers plans changes | www.ajc.com

Rate of Childhood Obesity Falls in Several Cities - NYTimes.com

Sex questions still not part of youth survey | Georgia Health News

Monday, December 10, 2012

Oxygen Deprivation in the Womb May Raise ADHD Risk

Could Kids' Salt Intake Affect Their Weight?

Fit Kids Finish First In The Classroom

Chambliss: President to get 'his way' on fiscal cliff | The Augusta Chronicle

Alcohol and youth: An unhealthy mix | Georgia Health News

The secret to a longer life? Children | www.ajc.com

Hospitals expected to benefit two ways from Medicaid expansion - amednews.com

CDC warns of early start to the flu season | www.ajc.com

Georgia agencies, school districts brace for fiscal cliff | www.ajc.com

Sunday, December 9, 2012

Pro & Con: Should Georgia expand Medicaid to cover uninsured? | www.ajc.com

Pediatricians: EHRs lacking in 5 main functions - amednews.com

Poor Diet During Pregnancy Predisposes Baby To Diabetes

New Genetic Testing Reveals More Prenatal Abnormalities

Can Teens' Lack of Sleep Lead to Diabetes?

Solving problems requires focus on fixes: Opposition to health care law in Georgia and elsewhere won’t help the 1 in 5 Georgians who lack insurance | Atlanta Forward

Friday, December 7, 2012

Suits allege wrongful baby deaths at South Fulton hospital | www.ajc.com

Thursday, December 6, 2012

A Blood Test for Autism? | TIME.com

Early flu season hitting some midstate schools | Education | Macon.com

Defeat on provider fee could gut hospitals’ finances | Georgia Health News

Hospitals consider benefits, costs of child life specialists - FierceHealthcare

Kids May Be at Slightly Higher Asthma Risk If Parents Had Infertility Treatments

Wednesday, December 5, 2012

KHN Changes How It Describes Medicaid Eligibility Level Under Health Law – Capsules - The KHN Blog

Study Foresees Shortage of Primary-Care Doctors

Azziz announces job cuts at GHSU | The Augusta Chronicle

Use Social Media to Fight Childhood Obesity, Heart Experts Say

Gov. Deal Looking For Consensus on Critical Revenue Stream for Poor Patients | WABE 90.1 FM

Doctors Who Work for Hospitals Face a New Bottom Line - NYTimes.com

Tuesday, December 4, 2012

RN-T.com - Lawmakers may debate Obama Medicaid expansion

U.S. Kids Might Not Be Over-Medicated After All

Teen Girls Who Smoke May Up Risk for Future Bone Disease

'Synthetic Pot' Sending Thousands of Young People to ER: Report

Chip Rogers leaving state Senate | www.ajc.com

New ED drama? Hospitals demand upfront fee for nonemergencies - amednews.com

Monday, December 3, 2012

U.S. birth rates hit hard by recession - latimes.com

Nearly half of U.S. docs use e-prescribing - FierceHealthcare

Zeroing In On Asian-American Children At Highest Risk For Obesity

Tap-Water Chemical May Be Linked to Food Allergy

More U.S. Kids Get High-Radiation Scans, Study Says

'Hiding' Cigarettes in Stores Might Keep Kids From Smoking: Study

Insurance Surcharges Will Fund Most Online Exchanges Created Under Health Law - Kaiser Health News

Deal appoints new Senate floor leaders | Governor Nathan Deal Office of the Governor

Sunday, December 2, 2012

CDC projects huge diabetes jump in kids, teens | www.ajc.com

Revisiting key components of the Affordable Care Act - FierceHealthcare

A Q&A with Speaker David Ralston on ‘personhood,’ immigration, a new Georgia Dome and hospitals | Political Insider

Possible Affordable Care Act Glitch: Too Few Doctors

Helmets Do Save Lives on the Slopes, Research Shows

Could Baby's Crying Give Clues to Autism?

Times-Georgian - Hospital bed tax A health care decision looms

ACLU Says It Sues Georgia Over Law Limiting Abortions - Businessweek

Thursday, November 29, 2012

Options For Parents To Cover A Sick Child - Kaiser Health News

Victims Of Bullying Often Suffer Trauma Symptoms

Microneedle Patch For Measles Vaccine Could Boost Immunization Programs

Boys With Undescended Testicles at Higher Risk for Testicular Cancer: Study

Simple Formula May Predict Obesity Risk at Birth

In Georgia medical field, Spanish speakers wanted (and needed) | Georgia Health News

Wednesday, November 28, 2012

Steep Cigarette Tax Hike Could Save Lives, Money: Report

Some EHRs in danger of missing data connections - amednews.com

Editorial - Organized medicine moves to block end run on prompt pay for physicians - amednews.com

Patient satisfaction: When a doctor's judgment risks a poor rating - amednews.com

AMA meeting: Delegates adopt physician employment principles - amednews.com

Tuesday, November 27, 2012

Whooping Cough Vaccine Less Effective Over Time: Study

Medical Questions About Gun Ownership Come Under Scrutiny - Kaiser Health News

RN-T.com - Floyd Medical Center approves NICU expansion budget

OB/GYNs back over-the-counter birth control pills | Online Athens

Times-Georgian - Health care budget to be top issues in upcoming Assembly

Medicaid expansion would bring state $33 billion, cost it $2.5... | www.ajc.com

Grant funding brings produce to school cafeterias | Online Athens

Monday, November 26, 2012

Report takes new look at Medicaid expansion costs | Georgia Health News

Supreme Court Considers Whether GeorgiaHospital Merger Creates Monopoly

Supreme Court Considers Whether Georgia

Hospital Merger Creates Monopoly

By Jane Norman, CQ HealthBeat Associate Editor

Supreme Court justices Monday probed just how far a Georgia public hospital can go in acquiring another facility before the purchase raises federal antitrust concerns, in a case that’s gotten the attention of the hospital industry at a time of many mergers and consolidations.

The justices didn’t seem to reveal their opinions one way or the other. At one point, Justice Stephen G. Breyer declared: “I’m not at all decided.” Justice Ruth Bader Ginsburg pressed a Department of Justice lawyer to explain how a Georgia state law should have been worded to allow a hospital to acquire other properties.

The Federal Trade Commission has challenged the Hospital Authority of Albany-Dougherty County’s 2011 purchase of a competing private facility, Palmyra Park Hospital. The FTC says such a sale creates a monopoly that will drive up prices for consumers since they are the only two hospitals in a wide geographic area.

But the hospital authority contends that the merger was needed to provide enough beds for low-income patients and that Georgia law allows the purchase, even if it’s anti competitive, and so federal law doesn’t apply.

The two sides wound up at the high court after the FTC appealed a decision by the U.S. Court of Appeals for the 11th Circuit in favor of the hospital and a district court decision that also backed the hospital.

Justices asked questions about the reach and intent of a 1941Georgia state law that allowed the creation of county hospital authorities so that localities could better serve the poor. Under that law, the Albany-Doughterty County authority was formed, and it bought Phoebe Putney Memorial Hospital to operate as a public hospital. The authority ran the hospital until December 1990, when it formed two nonprofit corporations and one corporation leased the hospital operations to the other.

Though the hospital is now run as a corporation and through leases, its lawyers argue that the state law exempts it from federal antitrust laws through what’s known as the “state action” doctrine developed mostly in the courts. That essentially means the state in its laws has allowed certain conduct by its entities, in this case hospital mergers.

“In the specific area of local hospital services, the Georgia legislature has adopted a model of local public choice, including the choice to reduce or eliminate competition,” Seth Waxman, the lawyer for theGeorgia health system, said in his argument before the court.

Hospital Needed Beds

Waxman said Phoebe Putney, as it grew and handled more low-income patients, faced a need for more capacity. A new hospital could have been built, if permitted by the state. “Or we can talk with the private hospital about whether they would like to be acquired. And the record shows that they did that for many, many years, even before the Phoebe Putney entities were created,” Waxman said.

Chief Justice John G. Roberts Jr. noted that there were likely few hospitals in rural areas of Georgia in 1941 when the law was enacted, so there must have been an anticipation that monopolies might be created. “When this law was passed, giving them the power to acquire hospitals, wasn’t it the case that there would likely be only one other hospital or two, so that any acquisition of another hospital would have the merger consequences that this one had?” Roberts asked.

Benjamin J. Horwich, an assistant to the solicitor general arguing on behalf of the FTC, said that the justification for the state action doctrine is that the state is trying to pursue a policy that is part of its traditional prerogatives to regulate its own economy.

In this case, though, the FTC argues that all the state did was grant general corporate powers to the local hospital authorities to buy property, and it’s too broad of an authority to construe as permitting the merger and allowing a monopoly.

“If the state is not actually trying to advance some other policy with respect to the particular conduct at issue, then it can’t be said that the state has done something that federal law should stand aside for,” Horwich said.

In an analysis of the case, Peter C. Carstensen, a professor of law at the University of Wisconsin Law School, says that it represents the first time in nearly 20 years that the high court has looked at its standards for exemptions under the state action standard.

In the meantime, some lower courts have taken a broad view and exempted actions from antitrust law whenever the competitive harm was something that could reasonably have been foreseen by lawmakers. In other cases, courts have tried to figure out whether the question of competition was central in lawmakers’ minds.

The American Hospital Association and Georgia Hospital Association said in their brief that it’s important that valuable work by hospitals not be impeded by worries over antitrust issues. “AHA has a specific interest in this case, because many of its member hospitals are publicly owned and operated by state and local governments,” their brief said.

“More generally, the AHA has a longstanding interest in how the antitrust laws are applied to hospital mergers, which often foster, rather than diminish, competition, and in many cases are necessary for hospitals to deliver care effectively,” the brief said.

States Face Higher Medicaid Costs Even if They Don’t Expand Program, Kaiser Report Finds

States Face Higher Medicaid Costs Even if They Don’t Expand Program, Kaiser Report Finds

By Rebecca Adams, CQ HealthBeat Associate Editor

State officials who are hoping to avoid high Medicaid costs from the health care law by not expanding the program might be in for an unpleasant discovery: Other Medicaid-related mandates in the overhaul will mean higher state spending regardless of whether a state expands, according to a state-by-state analysis the nonpartisan Kaiser Family Foundation released Monday.

The report shows that if all states expand coverage, as allowed under the 2010 health care law, they would collectively spend $76 billion more from 2013 to 2022 on Medicaid than if the measure had never been enacted. That’s only about $8 billion more than states would pay under the law if none of them expand.

Most of the increase in Medicaid spending over the decade will come even if a state chooses not to broaden coverage. That’s because millions of people who are already eligible for the program are expected to sign up in 2014 when there’s likely to be massive campaigns to tell people about the new law. States also will have to spend more money updating their IT systems, changing their enrollment and eligibility procedures and helping people understand the new system, which is supposed to allow for seamless coverage.

The report also suggests that state costs for expansion would be modest compared to the amount that the federal government would pay. That $8 billion in additional investment would allow states to draw $800 billion more in federal funding than they would get under the law, if no states expanded.

Moreover, the report finds that some states would actually save money on the expansion, considering that they would have fewer uncompensated care costs to fund. States and localities bear about 30 percent of the costs of uncompensated care when uninsured patients don’t pay all of their medical bills. The report estimates that nationally, state and local spending on uncompensated care would decline by $18 billion — turning the total $8 billion cost to states under expansion into $10 billion in savings.

But each state would be affected differently, and some individual states would not fare as well as the national picture indicates.

“That might be true in the aggregate, but states are going to run the numbers themselves,” said former Congressional Budget Office Director Douglas Holtz-Eakin, who conducted a similar analysis earlier this year for the American Action Forum.

For example, if Mississippi decided to expand Medicaid, it would cost the state about 6.2 percent more than if the state does not expand, a higher percentage increase than any other state, the Kaiser report estimated. But the authors concluded that because the state would save money on uncompensated care costs, the true net increase would be 3.8 percent.

The report also found that the financial incentives were best for states in the New England and Mid-Atlantic regions, while they were least attractive in the Mountain and Pacific regions.

The 61-page report was conducted by Urban Institute researchers including John Holahan and Matt Buettgens.

The report could be helpful to governors and state legislators preparing for their 2013 legislative sessions and trying to decide whether to expand Medicaid under the 2010 law.

The overhaul law allows states to expand coverage for people whose household income is at or below 138 percent of the federal poverty level, which in 2012 is $15,415 for an individual and $26,344 for a family of three. The federal government will pick up most of the costs, starting at 100 percent for the newly eligible in the first three years and phasing down to 90 percent of costs. The June 28 Supreme Court decision made it clear that states would be able to choose whether or not to expand Medicaid without jeopardizing their federal matching money for their entire Medicaid programs. Since then, governors and state legislators have been weighing whether to broaden their Medicaid programs.

A Closer Look at the Numbers

The details work like this: Assuming all the states participate in the Medicaid expansion, their total projected costs would increase by $76 billion from 2013-2022, an average increase of about 3 percent nationally over current costs. For that investment, the states would gain $952 billion in federal funding to help pay for coverage for an additional 21.3 million people, the report said. Of that $952 billion, the federal government would have had to pay $152 billion in higher Medicaid costs even if the law hadn’t been passed.

Even if none of the states expand coverage, they still would be on the hook for a collective $68 billion over the same time period, because of other requirements in the law. If a state chooses not to broaden coverage, it still will have to simplify enrollment and eligibility procedures and help people understand their coverage options. Under that scenario, about 5.7 million people who are currently eligible but not enrolled in Medicaid would be expected to come out of the woodwork to sign up for coverage.

State officials who look at the Kaiser report will be asking themselves whether they can afford a slightly higher investment in order to significantly expand the number of people who will get coverage.

“It’s very easy to have a little sticker shock at the potential cost,” said Alan Weil, the executive director of the NationalAcademy for State Health Policy. Weil noted that even a 1 percent increase can seem like a lot to officials in states whose fiscal climate is still recovering. For years, many state officials have complained about the burden that Medicaid costs impose on their state budgets.

But Weil, who spoke on a conference call organized by Kaiser, said that the report does a good job of putting the spending burden that states will face in the context of overall spending.

“Many states will be surprised at the results showing that the costs to them of the coverage expansion in the ACA come largely from things that they must do” and not from the optional expansion, Weil said.

He suggested, as he has said before, that state officials will come under tremendous pressure from medical providers and patient advocates to consider the expansion.

Of course, the Obama administration also is pushing state officials to expand.

Holtz-Eakin said the administration’s interest gives states leverage they could use to strike deals on Medicaid or the exchanges with federal officials. For instance, GOP governors have sent the administration a list of ideas that they would like to pursue in Medicaid, and they might press federal officials harder to accept them. Republicans who have said they will rely on the federal exchange in their states also might be persuaded to work on a federal-state partnership if the administration shows a little more flexibility in Medicaid.

“I think that the major takeaway from this report and what we did is that the Medicaid expansion is not a no-brainer. States will have to think about it from their own narrow financial point of view,” he said. “The Supreme Court decision really did deal the states back in, and they can use that leverage.”

Link to full report: http://www.kff.org/medicaid/upload/8384.pdf

Wednesday, November 21, 2012

Grady could have big loss in Medicaid stand-off | www.ajc.com

Gov. Bentley says Alabama won't set up exchange, expand Medicaid

By Kim Chandler | kchandler@al.com The Birmingham News
on November 13, 2012 at 1:38 PM,

BIRMINGHAM, Alabama -- Gov. Robert Bentley, in a show of continued resistance to the Affordable Care Act, said this afternoon that he will not set up a state health care exchange and he will not expand Medicaid under the federal healthcare overhaul.

"I will not set up a state exchange in Alabama," Bentley said during a speech to the Birmingham Business Alliance.

States have a Friday deadline to inform the U.S. Department of Health and Human Services if they plan to set up a state-run exchange, essentially a marketplace for people and businesses to shop for insurance. If states don't set up their own exchange, either alone or in federal partnership, then the federal government will step in and design it.

Bentley said he has been in communication with other governors -- including peers in Texas, Florida andLouisiana -- about the exchange decision. He expected multiple governors to show a united front of resistance to the Affordable Care Act.

"If we stand together, I do believe Congress is going to have to look at this again," Bentley said.

Bentley said he expected other governors to announce similar decisions.

"That will send a clear signal to all of our elected leaders in Washington that the health care bill should be changed," Bentley said.

Bentley questioned the constitutionality of the federal government stepping in and setting up essentially a state agency through a federally designed exchange. Oklahoma has filed a lawsuit alleging that it is unlawful for the federal government to establish an exchange within a state, Bentley noted.

"We believe the federally facilitated system they will try to set up, we believe that is unconstitutional," Bentley said.

Bentley said a state study commission had estimated previously that a state exchange would cost up to $50 million annually to operate. He said the state cannot afford that. The commission estimated that the cost to operate an exchange in 2015 would range between $34 million and $49.6 million.

The exchanges -- whether run by the state or the federal government -- are supposed to be in place by 2014.

Bentley said he will also refuse to expand Medicaid as it currently exists under the Affordable Care Act. The expansion would have been paid for almost entirely by the federal government, but Bentley questioned the long-term cost to both the state and nation.

"I will not expand Medicaid as it exists under the current structure because it is broken," Bentley said." We just cannot afford it. The people of America cannot afford it."

Bentley, who is a doctor, said his decision to resist the Affordable Care Act was based on a difference of philosophy, not politics.

"It is, in my opinion, truly the worst piece of legislation that has ever been passed in my lifetime," Bentley said of the ACA.

Senate Minority Leader, Roger Bedford, D-Russellville, criticized the governor's decision on both the exchange and Medicaid expansion.

"It's a total shame. It's a complete failure of leadership by the Republican supermajority. What this means is Washington will run Alabama's healthcare system not Alabama," Bedford said.

Bedford said the state should also grab an opportunity to expand Medicaid with the federal government picking up most of the tab.

"There are 350,000 people that could get preventive care rather than showing up in an emergency room,"Bedford said.

Speaker of the House Mike Hubbard, R-Auburn, said he applauded Bentley's "principled stand against Obamacare." Hubbard said implementing the Affordable Care Act would bloat government and putAlabama on a path to "fiscal disaster."

"The governor is in discussions with roughly two dozen of his counterparts in other states to coalesce against Obamacare and push back against its mandates. It's my hope that this coalition can send a wake-up call to Washington and reverse the dangerous trend of liberal policies and directives that Obama and Congressional Democrats are pushing so hard to implement," Hubbard said.

An advocacy group for low-income families expressed disappointment in Bentley's decisions.

"We're disappointed that the governor would close these doors for now. We think Alabamians deserve as good a deal from healthcare reform as folks in other states are getting, " Jim Carnes, communications director for Arise Citizens' Policy Project.

In Alabama about 351,000 people, including 244,804 previously uninsured, would join Medicaid under an expansion, according to 2010 estimates from the Henry J. Kaiser Family Foundation.

The suggested expansion would open Medicaid to adults younger than 65 with an income of less than 133 percent of the federal poverty level, which would be $14,856 for individuals and $30,657 for a family of four. The federal government would pay 100 percent of the cost of services for new enrollees for the first three years, but that eventually would drop to 90 percent.

"This offers us the opportunity to get hundreds of thousands who have no healthcare into preventive care. These are working people. They work in industries we all utilize every day -- restaurants, construction," Carnes said.

Bentley said people had assumed that after the election, the ACA could not be stopped.

"They're wrong," Bentley said.

He said the two key portions of the law are the Medicaid expansion and the exchanges.

"If we have a large enough number of states who refuse to do it, it is going to be very difficult for them," Bentley said