House Democrats are planning to combine an expansion of children's health insurance with Medicare changes that include cuts in payments to private insurers who cover millions of seniors in Medicare Advantage plans.
According to a new bill summary, Democrats plan a $50 billion expansion of the State Children's Health Insurance Program, which covers about 6 million children from low-income families not poor enough to qualify for Medicaid.
The expansion would bring total spending on SCHIP to $75 billion over the next five years $35 billion more than the government has spent over the last 10 years, and $45 billion more than President Bush has proposed to spend in the future.
Bush has already threatened to veto a $35 billion expansion approved by the Senate Finance Committee last week. The full Senate is expected to vote on that measure before starting its August recess...''
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Stray thoughts. SCHIP, stands for State Children's Health Insurance Program. It is a component of Medicaid.
Most people involved in the universal healthcare drive and debates don't seem to have an overly broad understanding of how the government works and the legislative background of Medicare and Medicaid. At the risk of boring LBO, here are some additional details. They are important to understand since any model of universal healthcare, will inevitably be modeled on Medicare and Medicaid. Why? Because the system already exists, and it is legislatively rather trivial to expand its scope.
Medicare and Medicaid are national healthcare programs implemented under the Social Security Administration in the mid-60s. They had two separate focuses. Medicare was originally designed to supply healthcare services to Social Security recipients. These included the retired and the spouses and non-adult-children of Social Security beneficiaries who died. The original idea was to provide healthcare to retired workers, and their widows and orphans who lived passed the death of the original beneficiary. Medicare was not, underline not, what is called a needs based system. It was like Social Security benefits. You qualify for Social Security no matter what your income level. Of course the more you paid into the system, the more you would receive. So, in effect Social Security perpetuated the class system, by design. Work hard and be poor all your life, then you will die poor.
Medicaid was originally designed for the poor and was a needs based system. Your income level must be below the federally determined ``poverty line'' in order to qualify for the healhcare benefits of Medicaid. Medicaid in addition is funded in a federal matching proportion with the States. Each State sets it state-side budget for receiving matching federal Medicaid funds. The States may in addition implement various auxiliary programs that mandate coverage over and above the federal legislative minimum requirements. The State regulations covering Medicaid beneficiaries must only meet the federal minimum standards. They are free to change the federal minimums, as long as the result is that everyone covered also meets the federal standards. From the state's point of view there are benefits and drawbacks. If the State wishes to expand the coverage beyond the federal guidelines, say some point above the federal poverty line, they can, as long as the individual State supplies the extra funding.
Over the forty years since these relatively clear guidelines were implemented, there has been a long history of battle between the State and the Federal government to push various categories of recipients from one branch of these programs to another. For example, in California, if you qualify for Medical the state name for its Medicaid funded program, and you have some income from working, no matter how little, if the paycheck paid into the Social Security system, then Medical can divert your coverage to Medicare as the primary carrier.
There are many, many other state guidelines that mix and match coverage to dodge paying state funds for healthcare, even if it is technically mandated to do so.
In various battles at the federal level to privatize Medicare, all sorts of provisions have been added to the original legislation to open up a sea of private insurance contracts to pay Medicare funds to private companies to cover, Medicare beneficiaries.
For the service provider network, the hospitals, doctors, specialists, paramedical professions, medical labs, drug companies, and at the very bottom of the heap, durable equipment manufactures and suppliers, this strange and incoherent system of coverages from multiple sources that combined poverty level Medicaid, non-needs based Medicare, and supplemental private insurance has created the nightmare shown on Michael Moore's Sicko. (Haven't seen it, but this is a real system, that I deal with everyday)
>From my perspective it is possible to generate a document bundle of
more that twenty pages of forms, doctor's, therapist's, and social
worker's support letters detailing the need, along with authorizations
or denials of coverage from competing sources, and other ancillary
documents to change a bad wheelchair motor.
The game here is to shift claim payment responsibility among multitude and plenty of every conceivable provider, but yourself.
In concrete terms, all this means that I saw a guy in May and wrote up a long list of repairs his powerwheel needed. It is July 23. Word came today, in the mid-afternoon that this guy's repair authorization process was complete and he could be scheduled for the repairs. He has Medicare, Medical, and supplemental private insurance.
Intuitive it would seem with this plethora of coverage sources, our customer should be at the top of the benefit heap. He isn't. He is at the bottom, precisely because of these overlapping coverage systems. Each provider denies its claim with the argument that the other providers are mandated to pay for the claim. As a consequence, what seems like a forest, is reduced to a desert through the magic filter of the exclusion operator.
Healthcare coverage works as a intersection operator in such a way that the more providers there are, the less area of the intersection of coverage. I leave it to the math crew to explain how this works---something about the growth of the excluded middle, or the decrease of the included middle.
It means with each additional provider, the area of the neighborhood decreases with each additional intersection. It does not increase. So it is possible with an infinite number of intersecting providers, the limit with each additional provider added, approaches zero coverage. Ah, the miracle of analytical point sets.
Whether the healtcare industry understood this principle and acted on it accordingly is not as important as the fact they intuited it as the best policy they could pursue.
Crudely, it means the best way to cover nobody is to fabricate as many slightly different plans as possible, offered to as many as possible, each emphasizing a slightly different point set area.
In this sense, then the competition of the marketplace where each provider offers a slightly different option set, effectively reduces the potential coverage of the population as a whole. The more plans offered, the less claims any of them have to pay.
This is truly the mathematical beauty of the healthcare political economy.
I leave it as an exercise to the economists to explain how the free market effectively excludes everyone from healthcare coverage through an infinite set of competing provider coverage options.
Bottom line. The more providers competing in the market, the less coverage for the population as a whole, the less claims paid, the more profit for our special people, those forever wonderful capitalist pig hegemons. This is how neoliberalism works.
This general principle of generating many optional systems also works very well as a propaganda tool. For any given moment where univerbal healthcare reaches some pivotal turning point, it is always a good idea to generate as many slightly different plans as possible, so as to flood the world of ideas with utterly meaningless variants. Collectively these will muddy the waters of insight and divide the myriad of interests who have temporarily formed a coalition. Dissolve the coalition, and you dissolve any coherent movement.
CG