In Bensonhurst, Brooklyn, at the new R&G Social Adult Day Care Center, known locally among elderly immigrants for luring clients with cash and grocery vouchers, most people there for lunch did not stay to eat. Instead, many walked briskly toward the subway carrying bags stuffed with takeout containers, and two elderly men rode away on bicycles with the free food.
Not a wheelchair or walker was in sight at these so-called social adult day care centers. Yet the cost of attendance was indirectly being paid by Medicaid, under Gov. Andrew M. Cuomo‘s sweeping redesign of $2 billion in spending on long-term care meant for the impaired elderly and those with disabilities.
Such centers have mushroomed, from storefronts and basements to a new development in the Bronx that recently figured in a corruption scandal. With little regulation and less oversight, they grew in two years from eight tiny programs for people with dementia to at least 192 businesses across the city.
The patient needed a standard set of blood tests at LabCorp. The busy receptionist obligingly spent time querying her software to figure out the cash price for the tests. She came up with a quote of $537.00. Given the quote, the patient decided to go with his insurer’s network price.
As the statement of benefits shows, the network price was $68.63, a $468.37 saving over the cash price of $537.00.
This experience provides food for thought in several dimensions:
The State of Health Care Spending, by Andrew Rettenmaier and his colleagues:
The compendium is divided in two main parts. Part 1 summarizes the four ways by which the geography of health care spending is described. Health care spending as a percent of the states’ GDP is the first way in which the geography of health care is presented and is separated between Medicare, Medicaid, and non-Medicare/Medicaid spending. These data allow for analysis that extends back to 1980 for each state. Next, health care spending is analyzed on a per capita basis and is again divided between Medicare and Medicaid per enrollee in the programs, and average non-Medicare/Medicaid spending for the states’ population who are not enrolled in the programs. The second part of the compendium comprises 50 state summaries. The two-page summaries are based on the four ways of viewing geographic variation in health care spending and the health care markets. The first page summarizes the key health care spending indicators in each state, and provides graphical representations of how the state compares to the national average now and in the past. Also depicted is the variation in county level Medicare spending. The second page of each state’s summary presents all of the recent metrics in tabular form. Medicare spending in four large or geographically dispersed counties is also presented at the end of each table. (Summary by Michael Ramlet)
Tom Saving and I discuss some of the results at the Health Affairs blog.
State budgets are still under stress because revenues are not growing fast enough to replace the funding from the federal stimulus program. And now states are being pressured to expand Medicaid.
According to the National Association of State Budget Officers, Medicaid will account for 23.9 percent of total state expenditures in fiscal 2012. In most states, able-bodied working age adults are not eligible for Medicaid. One of the pillars of ObamaCare was the provision requiring states to either expand Medicaid to everyone with incomes up to 133 percent of the federal poverty level (plus a five percent income set-aside) or lose all of their federal matching funds. This provision was struck down by the Supreme Court.
But state governments are still being pressured to expand Medicaid, even though estimates suggest that more than 25 percent of people in the expansion group have private health coverage and that a sizeable fraction of them are college students. The federal government promises to pay 100 percent of Medicaid medical costs for the first three years of the expansion, and 90 percent of them in 2020 and thereafter. A variety of interest groups think that it would be a shame to leave this “free” money on the table.
Two nights a year, Tennessee holds a health care lottery of sorts, giving the medically desperate a chance to get help. State residents who have high medical bills but would not normally qualify for Medicaid, the government health care program for the poor, can call a state phone line and request an application. But the window is tight — the line shuts down after 2,500 calls, typically within an hour — and the demand is so high that it is difficult to get through.
On February 15, the Centers for Medicare and Medicaid Services announced its intention to reduce payments to Medicare Advantage (MA) plans by 7 to 8 percent in 2014…
More than 14 million beneficiaries enrolled in MA plans will be affected in some way by this cut. Low-income beneficiaries have the most to lose. According to America’s Health Insurance Plans, the insurance industry trade association, 41 percent of MA enrollees in 2011 had incomes of $20,000 or less. Medicare Advantage is attractive to those with low incomes because private plans offer a better deal.
In February, the Centers for Medicare and Medicaid Innovation (CMMI) sent out the 31 proposed quality targets that pioneers would have to meet if they wanted to receive bonus payments. Bonuses would be based on their ability to meet those targets beginning in 2013. But then, last week, 30 of the pioneers sent a letter to CMMI complaining that at least 19 of the quality targets had too little data behind them and were therefore unfair, unreasonable and even arbitrary.
More on accountable care strategies in the Kaiser Health News blog.