Many hospitals are struggling under the burden of caring for the indigent. There are some interesting findings from first quarter reports regarding this.

Quote:The Hospital Corporation of America, which has facilities in 20 states, reported a big gap in Medicaid and uninsured admissions between expansion and non-expansion states. In the four states it operates where Medicaid expanded under the ACA, the company saw a 22.3 percent growth in Medicaid admissions, compared to a 1.3 percent decline in non-expansion states. The company also had a 29 percent decline in uninsured admissions in the expansion states, while non-expansion states experienced 5.9 percent growth in uninsured admissions, chief financial officer William Rutherford said.

Community Health Systems, with facilities in 29 states, also noticed an expansion gap. In expansion states it serves, CHS said it saw self-pay admissions drop 28 percent while Medicaid admissions increased by 4 percent. Self-pay emergency room visits decreased 16 percent in expansion states, but they increased in non-expansion states, the company said in its earnings call last week.

Tenet Healthcare reported last week that it had a 17 percent increase in Medicaid inpatient visits while uninsured visits decreased 33 percent in the four expansion states where it operates. In non-expansion states, Medicaid admissions dropped 1 percent as uninsured care rose 2 percent. Tenet also said it's seeing that emergency room visits are continuing to rise.

http://www.washingtonpost.com/blogs/wonk...expansion/

Indiana appears to be headed toward expansion now. It is a private version so it provides some cover for the GOP governor. He can call it whatever he wants if it gets implemented. I just hope this will be the model for other GOP controlled states like mine to provide coverage. It would certainly be of great benefit to both our citizens and our rural hospitals.

Quote:Pence, like Ohio Gov. John Kasich and New Jersey Gov. Chris Christie before him, announced a major push Thursday to expand Medicaid under the health care law and follow 26 states that have extended coverage to a larger share of their low-income residents.

Read more: http://www.politico.com/story/2014/05/mi...z31ovVyi8d

(05-15-2014 04:17 PM)dawgitall Wrote:  Indiana appears to be headed toward expansion now. It is a private version so it provides some cover for the GOP governor. He can call it whatever he wants if it gets implemented. I just hope this will be the model for other GOP controlled states like mine to provide coverage. It would certainly be of great benefit to both our citizens and our rural hospitals.

Quote:Pence, like Ohio Gov. John Kasich and New Jersey Gov. Chris Christie before him, announced a major push Thursday to expand Medicaid under the health care law and follow 26 states that have extended coverage to a larger share of their low-income residents.

Read more: http://www.politico.com/story/2014/05/mi...z31ovVyi8d

It's a fool errand and I hope we never have that in this State. It's a promise of riches from the Feds, and there's a problem there. The Fed is broke. As in, in the gutter, brown paper bag, 40 in one hand, busted asss shopping cart filled with trashbags full of "belongings" in the other, broke.

The numbers are something like 100% for a few years, then 90% from there on out or whatever. It will only be a matter of time, a short time I am quite confident, that those "measures" will be "adjusted" as well. With, once again, the States holding the bag for yet another unfunded mandate.

States don't have the flexibility that the Feds do to run colossal and unsustainable deficits and debt like the path the Feds have us on. So soon enough the States will be broke as well. Then what? There will have to be MASSIVE cuts elsewhere, so who's going to be paying up? Will it be the State employees getting laid off? Where are most of them located? Will it be at the expense of infrastructure? That's strained enough already.

My guess is it will be a money grab similar to the Social security scam and it will be a raid on public employee pension funds, to be replaced with "IOU's" like the Feds have done. Bond ratings will plummet, interest rates will necessarily go up and the cost for those States to borrow further will be greatly hampered.

Then where do they turn? Perhaps the Tooth Fairy and her seeming endless supply of money, or maybe they can pimp further lotteries and gambling. Some choices.

No thanks. If you are placing your trust in the Feds to play this straight, I think you're (you, as in the generic, not specifically YOU Dawg) nuts. Just look how they've conducted themselves of late.

no way. bad, bad idea.

(05-15-2014 04:59 PM)JMUDunk Wrote:  

(05-15-2014 04:17 PM)dawgitall Wrote:  Indiana appears to be headed toward expansion now. It is a private version so it provides some cover for the GOP governor. He can call it whatever he wants if it gets implemented. I just hope this will be the model for other GOP controlled states like mine to provide coverage. It would certainly be of great benefit to both our citizens and our rural hospitals.

Quote:Pence, like Ohio Gov. John Kasich and New Jersey Gov. Chris Christie before him, announced a major push Thursday to expand Medicaid under the health care law and follow 26 states that have extended coverage to a larger share of their low-income residents.

Read more: http://www.politico.com/story/2014/05/mi...z31ovVyi8d

It's a fool errand and I hope we never have that in this State. It's a promise of riches from the Feds, and there's a problem there. The Fed is broke. As in, in the gutter, brown paper bag, 40 in one hand, busted asss shopping cart filled with trashbags full of "belongings" in the other, broke.

The numbers are something like 100% for a few years, then 90% from there on out or whatever. It will only be a matter of time, a short time I am quite confident, that those "measures" will be "adjusted" as well. With, once again, the States holding the bag for yet another unfunded mandate.

States don't have the flexibility that the Feds do to run colossal and unsustainable deficits and debt like the path the Feds have us on. So soon enough the States will be broke as well. Then what? There will have to be MASSIVE cuts elsewhere, so who's going to be paying up? Will it be the State employees getting laid off? Where are most of them located? Will it be at the expense of infrastructure? That's strained enough already.

My guess is it will be a money grab similar to the Social security scam and it will be a raid on public employee pension funds, to be replaced with "IOU's" like the Feds have done. Bond ratings will plummet, interest rates will necessarily go up and the cost for those States to borrow further will be greatly hampered.

Then where do they turn? Perhaps the Tooth Fairy and her seeming endless supply of money, or maybe they can pimp further lotteries and gambling. Some choices.

No thanks. If you are placing your trust in the Feds to play this straight, I think you're (you, as in the generic, not specifically YOU Dawg) nuts. Just look how they've conducted themselves of late.

no way. bad, bad idea.

There can be a provision in the state law that ends the program if the federal portion is ever cut below 90%.

dawg... much of this is statistical double-speak...

a 28% drop in self-pay could EASILY equate a 4% rise in Medicaid admissions.... If there were 100 self-pay and 700 Medicaid before.... and 28 formerly uninsured now had Medicaid. Those sorts of numbers are fairly realistic in most places.

As for provisions to end the law if federal funding is cut, that doesn't make any difference if everyone has now adjusted to the new reality. The state law can't conflict with the Federal Law, so while they may change the program, they can't simply 'not comply' with the Federal law.... and it is the compliance that costs money. This is a bell that is extremely difficult to un-ring.

Why should the states take on the risk to provide it if insurers will? That is their leverage should the feds under-fund it. The States didn't make the demands, the Feds did.

That's a bit like an employer insisting you join a gym (buy insurance) and telling you he will pay the fees... The gym raises it's membership rates and the employer doesn't pay you any more money. How are you supposed to comply with the mandate to have a membership? Should your parents (the state) come in and take that risk for you? Or should the employer just pay the gym for you?

If you're willing to take the risk so that you don't have to use the gym by the office but can instead pick the one by your home... or alternatively pay a little more and get a better gym... that should be your right... but why in the world should your parents cosign on that for you?

(05-15-2014 05:47 PM)Hambone10 Wrote:  dawg... much of this is statistical double-speak...

a 28% drop in self-pay could EASILY equate a 4% rise in Medicaid admissions.... If there were 100 self-pay and 700 Medicaid before.... and 28 formerly uninsured now had Medicaid. Those sorts of numbers are fairly realistic in most places.

As for provisions to end the law if federal funding is cut, that doesn't make any difference if everyone has now adjusted to the new reality. The state law can't conflict with the Federal Law, so while they may change the program, they can't simply 'not comply' with the Federal law.... and it is the compliance that costs money. This is a bell that is extremely difficult to un-ring.

Why should the states take on the risk to provide it if insurers will? That is their leverage should the feds under-fund it. The States didn't make the demands, the Feds did.

That's a bit like an employer insisting you join a gym (buy insurance) and telling you he will pay the fees... The gym raises it's membership rates and the employer doesn't pay you any more money. How are you supposed to comply with the mandate to have a membership? Should your parents (the state) come in and take that risk for you? Or should the employer just pay the gym for you?

If you're willing to take the risk so that you don't have to use the gym by the office but can instead pick the one by your home... or alternatively pay a little more and get a better gym... that should be your right... but why in the world should your parents cosign on that for you?

We will certainly have to follow the trends beyond just a one quarter window. I would think the increase in Medicaid admissions would be a direct result of the expanded Medicaid coverage since there is a significant difference between the states where there was no expansion and those where there was. The reduction in the number of uninsured admissions I would think would be more a reflection of the ACA as a whole rather than just the expanded Medicaid. But this is a very limited look in. We will know much more down the road a year or two.

(05-15-2014 05:47 PM)Hambone10 Wrote:  dawg... much of this is statistical double-speak...

a 28% drop in self-pay could EASILY equate a 4% rise in Medicaid admissions.... If there were 100 self-pay and 700 Medicaid before.... and 28 formerly uninsured now had Medicaid. Those sorts of numbers are fairly realistic in most places.

As for provisions to end the law if federal funding is cut, that doesn't make any difference if everyone has now adjusted to the new reality. The state law can't conflict with the Federal Law, so while they may change the program, they can't simply 'not comply' with the Federal law.... and it is the compliance that costs money. This is a bell that is extremely difficult to un-ring.

Why should the states take on the risk to provide it if insurers will? That is their leverage should the feds under-fund it. The States didn't make the demands, the Feds did.

That's a bit like an employer insisting you join a gym (buy insurance) and telling you he will pay the fees... The gym raises it's membership rates and the employer doesn't pay you any more money. How are you supposed to comply with the mandate to have a membership? Should your parents (the state) come in and take that risk for you? Or should the employer just pay the gym for you?

If you're willing to take the risk so that you don't have to use the gym by the office but can instead pick the one by your home... or alternatively pay a little more and get a better gym... that should be your right... but why in the world should your parents cosign on that for you?

The SCOTUS ruled that states couldn't be required to expand Medicaid so there wouldn't be a conflict between state and fed law. States can opt in or out and can start and later stop the program. But I do agree that it will be difficult to end the program once it has been offered. It can be done though.

Yeah this **** is great......errrrr

See California $1.2 BILLION over original estimate.



Sent from my SAMSUNG-SM-N900A using Tapatalk

Dawg...
I don't know how your response addresses my comment at all. The states dont' have to expand medicaid... but they can't offer plans that don't comply with Obamacare's mandates... If they expand medicaid on the hope that the feds will pick up the bill, and the feds back off (there is no legal requirement for them to pay 90%) then they are in the position of being 'the bad guy' when they cancel those policies as a result of the feds changing their deal... or significantly increase taxes or cancel other spending to make up the difference. It makes the states responsible for the feds actions... basically cosigners on the fed's loan. Surely you can understand why politicians don't want to be at the whims of another branch of government already strapped for cash. Does it happen? Sure... but it is not without significant risks... and depending on the makeup of your state... those risks may be too large to take.



And these aren't 'trends', but the reality of hospital reimbursement. Hospitals are required to offer services... nobody can be turned away. If you have insurance, they get billed... If you don't, they try and qualify you under medicaid. If they can't, then they apply to state or county funds for indigent care... and if they don't get that, they write it off on their taxes. All the numbers you present show is that some people who would formerly not qualify under 'old' medicaid (including those who could afford, but didn't buy insurance) now qualify under expanded medicaid. This is not a revalation, nor does it mean that any more money is actually reaching hospitals for the care provided... it merely means that if you expand the eligibility, more people will qualify.... and it is the hospitals, not the people who are signing them up... because this is how they try and get paid.

Well, no kidding.

Some states have large funds for indigent care and net reimbursements (including tax incentives) are actually lower under 'insurance' than they were under that plan. Some have small funds and reimbursements are a bit higher. I can speak with some knowledge about California, Oregon, Arizona and Texas.



Posted from my mobile device using the CSNbbs App

(05-15-2014 05:32 PM)dawgitall Wrote:  

(05-15-2014 04:59 PM)JMUDunk Wrote:  

(05-15-2014 04:17 PM)dawgitall Wrote:  Indiana appears to be headed toward expansion now. It is a private version so it provides some cover for the GOP governor. He can call it whatever he wants if it gets implemented. I just hope this will be the model for other GOP controlled states like mine to provide coverage. It would certainly be of great benefit to both our citizens and our rural hospitals.

Quote:Pence, like Ohio Gov. John Kasich and New Jersey Gov. Chris Christie before him, announced a major push Thursday to expand Medicaid under the health care law and follow 26 states that have extended coverage to a larger share of their low-income residents.

Read more: http://www.politico.com/story/2014/05/mi...z31ovVyi8d

It's a fool errand and I hope we never have that in this State. It's a promise of riches from the Feds, and there's a problem there. The Fed is broke. As in, in the gutter, brown paper bag, 40 in one hand, busted asss shopping cart filled with trashbags full of "belongings" in the other, broke.

The numbers are something like 100% for a few years, then 90% from there on out or whatever. It will only be a matter of time, a short time I am quite confident, that those "measures" will be "adjusted" as well. With, once again, the States holding the bag for yet another unfunded mandate.

States don't have the flexibility that the Feds do to run colossal and unsustainable deficits and debt like the path the Feds have us on. So soon enough the States will be broke as well. Then what? There will have to be MASSIVE cuts elsewhere, so who's going to be paying up? Will it be the State employees getting laid off? Where are most of them located? Will it be at the expense of infrastructure? That's strained enough already.

My guess is it will be a money grab similar to the Social security scam and it will be a raid on public employee pension funds, to be replaced with "IOU's" like the Feds have done. Bond ratings will plummet, interest rates will necessarily go up and the cost for those States to borrow further will be greatly hampered.

Then where do they turn? Perhaps the Tooth Fairy and her seeming endless supply of money, or maybe they can pimp further lotteries and gambling. Some choices.

No thanks. If you are placing your trust in the Feds to play this straight, I think you're (you, as in the generic, not specifically YOU Dawg) nuts. Just look how they've conducted themselves of late.

no way. bad, bad idea.

There can be a provision in the state law that ends the program if the federal portion is ever cut below 90%.

Right.

Tell me about the last "program" that EVER ended.

They cries of "millions of people losing their healthcare", "Don't you care about the sick and children?" and what ever other inflammatory rhetoric would be deafening. Like putting toothpaste back in the tube, it ain' gonna happen.

So, let's just assume that's true (cause in this case it would be) what then? Thoughts?

(05-16-2014 12:14 PM)JMUDunk Wrote:  

(05-15-2014 05:32 PM)dawgitall Wrote:  

(05-15-2014 04:59 PM)JMUDunk Wrote:  

(05-15-2014 04:17 PM)dawgitall Wrote:  Indiana appears to be headed toward expansion now. It is a private version so it provides some cover for the GOP governor. He can call it whatever he wants if it gets implemented. I just hope this will be the model for other GOP controlled states like mine to provide coverage. It would certainly be of great benefit to both our citizens and our rural hospitals.

Quote:Pence, like Ohio Gov. John Kasich and New Jersey Gov. Chris Christie before him, announced a major push Thursday to expand Medicaid under the health care law and follow 26 states that have extended coverage to a larger share of their low-income residents.

Read more: http://www.politico.com/story/2014/05/mi...z31ovVyi8d

It's a fool errand and I hope we never have that in this State. It's a promise of riches from the Feds, and there's a problem there. The Fed is broke. As in, in the gutter, brown paper bag, 40 in one hand, busted asss shopping cart filled with trashbags full of "belongings" in the other, broke.

The numbers are something like 100% for a few years, then 90% from there on out or whatever. It will only be a matter of time, a short time I am quite confident, that those "measures" will be "adjusted" as well. With, once again, the States holding the bag for yet another unfunded mandate.

States don't have the flexibility that the Feds do to run colossal and unsustainable deficits and debt like the path the Feds have us on. So soon enough the States will be broke as well. Then what? There will have to be MASSIVE cuts elsewhere, so who's going to be paying up? Will it be the State employees getting laid off? Where are most of them located? Will it be at the expense of infrastructure? That's strained enough already.

My guess is it will be a money grab similar to the Social security scam and it will be a raid on public employee pension funds, to be replaced with "IOU's" like the Feds have done. Bond ratings will plummet, interest rates will necessarily go up and the cost for those States to borrow further will be greatly hampered.

Then where do they turn? Perhaps the Tooth Fairy and her seeming endless supply of money, or maybe they can pimp further lotteries and gambling. Some choices.

No thanks. If you are placing your trust in the Feds to play this straight, I think you're (you, as in the generic, not specifically YOU Dawg) nuts. Just look how they've conducted themselves of late.

no way. bad, bad idea.

There can be a provision in the state law that ends the program if the federal portion is ever cut below 90%.

Right.

Tell me about the last "program" that EVER ended.

They cries of "millions of people losing their healthcare", "Don't you care about the sick and children?" and what ever other inflammatory rhetoric would be deafening. Like putting toothpaste back in the tube, it ain' gonna happen.

So, let's just assume that's true (cause in this case it would be) what then? Thoughts?

Long term unemployment benefits in NC.

Tennessee discontinued it's Medicaid expansion in 2003. The system almost bankrupted the state.

I'd say that's much of the reason that Tennessee hasn't expanded Medicaid.