I could not marry to improve our lives, could not own property, could not save money, could not make any real substantial money, and then I had to sign a paper regarding the Medicaid Estate Recovery Act. If that is not a money grab, I do not know what is.

I did not even want to be on Medicaid! But no insurance co would let me in.

Are 16 million people ready to deal with all that?! To have states reserve the ability to steal you whole estate instead of leaving it to your heirs? To spend down each month? To NOT save money in this recession?

After being on Medicaid, I can say putting that many people on a system that is means-tested and requires that you stay poor (even with the new eligibility) is the stupidest, unthinking plan in the world.

Has no on looked into the unintended consequences? And what of those who DO keep $1 over the amount? Will they be able to buy into exchanges for the month they have $1 over and then have to reaplly when that dollar is gone?

What about those who are Dual Eligible and lose Medicaid? As is now, they are often banned from Medicare supplements. Will the neediest suddenly be the most under insured?

Does anyone think in DC anymore or is this all just a runaway train? !

It is completely true that, in my 25 years in the industry, I’ve never once had a carrier drop an insured because they got sick, as has been claimed by those who are pro-Reform. Only as a result of Reform are we now seeing insurance companies drop categories of care. A couple have notified us, with more expected, they will discontinue offering “child only” policies. While they’ve not directly said it, everyone suspects the new pre-existing condition rules for children to be the reason. We’re watching insurance companies increase premiums, assigning values to various parts of the non-grandfathered changes. Many have changed their plan designs or reduced benefits, as well. Consumer oriented plans are especially taking a beating. One insurance company (we don’t have any business placed with them) sent a letter last week advising brokers they were withdrawing from the marketplace nationwide, citing Reform as the reason. Their policy holders will be unceremoniously terminated in February.

A concierge colleague, John Blanchard M.D.,is working on innovative solutions for Medicaid in Michigan. I am working on that in Texas. We feel that states would decrease Medicaid costs tremendously if patient’s had a patient centered medical home with a direct practice “concierge” physician.
States could develop a primary care medical stamp much like the food stamp. This would be redeemed only in a primary care practice with basic parameters set for access to quality care at a reasonable cost. Some ideas are to limit practice size, 24/7 access to your physician by cell phone, txt, same day access…etc.) The state would know exactly what they are contributing. Physicians may charge whatever they want as long as the patient pays the difference.
They have estimated a savings of $680-790 million in Michigan…

JG…..Solutions for your patients noted:
1. for asthma medications….call me on my cell..I’ll have it ready in 15 minutes at the closest pharmacy.
2. severe dental infections: call me on my cell..I’ll have it ready in 15 minutes at the closest pharmacy (generic please)
3. Colon cancer…..Everyone should get a physical yearly to screen for cancers. My unemployed, uninsured patients get that at the county hospital….. If they need help navigating the system, I call their specialist personally.
4. Maryland Medicaid refused to pay for life-saving liver transplants for two children — arguing that while the procedure was medically necessary, it was not appropriate…….
I may not be able to help with this one, but I guarantee you Medicaid will be hearing from me personally.

Writing a check is the difference between commitment
and conversation…”Warren Buffett”

We’ll see if state governments are willing to think out of the box and write some checks for patients in need of primary care….

Because health care is not the real issue with the left. Government control of the economy is. Any convenient half-truth or outright lie is fine with them as long as it furthers their cause.

On the means testing, if we are going to have the program the way it is (which we shouldn’t), then one of the biggest problems is that the means testing is often a “cliff edge,” or quantum steps at best. In this day and age (computers, remember?), there is nothing wrong with a continuously transitioning subsidy to the person that can be used to substitute employer coverage, for example, rather than cutting them off in total from Medicaid the instant their income exceeds a given amount. Need is not discrete.

The horrendous budgetary result from RomneyCare suggest that the lack of an individual mandate was not TennCare’s problem.