Medicaid

COST: Making Sure the Kids Are All Right

Joanne Kenen — Fri, 02 May 2008 19:53:00 -0400

First Focus, a children's advocacy group, this week in its Children's Budget 2008 reported that only one cent of each "new" dollar of federal spending (excluding defense) goes to kids. A lot of the report focused on education, so we asked them how does health spending add up. The answer: not so hot.

The overall share of federal, non-defense spending going to children's programs has dropped by 10 percent over the past five years. Real discretionary spending on children has declined by more than 6 percent since 2004, while at the same time all other non-defense discretionary spending has increased by more than 8 percent, the group reported.

Because so much of spending on children' health is through Medicaid, SCHIP, and other entitlements, not out of the discretionary budget, spending on health programs did grow from 2004–08. However, total spending on children's health amounts to less than 2 percent of the total federal budget, and less than 0.4 percent of the Gross Domestic Product.

Outside the mandatory programs, discretionary spending on children's health has declined in real terms. Discretionary spending is down 6.3 percent. As a share of total federal spending, children's health spending has lost ground. Children's health spending currently makes up 1.9 percent of all federal spending, while in 2004 its share was 1.97 percent, a 3.5 percent drop.

In addition, the $35 billion SCHIP proposal, which President Bush vetoed, represented one-quarter of 1 percent of the federal budget.

We believe that the entire health system needs to be overhauled for both equity and efficiency, which includes looking comprehensively at our kids' health and how we spend federal dollars. But these trends concern us. Investing in children means investing in their health and wellness. It will pay off in countless ways. Short term budget fights and long-term reform efforts have to make sure that, as this group's name implies, we first focus on what really matters.

COST: What's Love Got to Do With It?

Joanne Kenen — Tue, 29 Apr 2008 22:30:00 -0400

Forget pheromones. A new poll from the Kaiser Family Foundation found that seven percent of adults reported that in the past year they or someone in their household decided to get married in order to get health insurance from a spouse. (We don't even want to think about what their bridal gift registry looks like.)

The Kaiser poll had lots of somber news as health care costs are taking their toll on American families (including the middle class) during the economic downturn. Twenty-eight percent report that they or their families have had a serious problem paying for health care, behind paying for gas (44 percent) and about tied with getting a good-paying job or raise in pay (29 percent). Smaller shares report serious problems paying their rent or mortgage (19 percent), dealing with credit card or other personal debt (18 percent), paying for food (18 percent) or losing money in the stock market (16 percent). That 28 percent figure was true as well for middle class families, making between $30,000 and $75,000.

"Many people view health and the economy as separate issues, but the cost of health care is a significant pocketbook issue for many families and paying for health care has become a key dimension of the public's economic concerns," Kaiser Family Foundation President and CEO Drew Altman said.

Health costs aren't just sending families reeling; states are also facing huge pressures, according to a separate report this week from the Kaiser Commission on Medicaid and the Uninsured.

Each time the national unemployment rate goes up one point, another 1.1 million people become uninsured. The study's authors also projected that a million people would join either Medicaid or the State Children's Health Insurance Program (to the tune of $3.4 billion) while states have less money to spend on Medicaid, kids, schools and everything else - all of which tends to make the economic hole even deeper. All this when Congress and the White House are battling over new rules that would reduce federal spending on Medicaid, which is a joint federal-state program.

As the report by Stan Dorn and other Urban Institute researchers concluded:

As a new economic downturn unfolds, many states appear headed for serious budget shortfalls. Economic hard times reduce state revenues and increase the number of people who qualify for need-based benefit programs. Because of state balanced budget requirements, these trends eventually cause many states to increase taxes and fees or cut Medicaid, SCHIP, and other services. As a result, economic stimulus and help for vulnerable residents are withdrawn precisely when they are most needed.

Jane Sarasohn-Kahn over at Health Populi blogged about these studies today, tying the concern about health to the growing hard times and a credit crunch that could go on for some time. She noted that stores have been rationing rice - so we probably can't even throw it at those newly-insured newlyweds.

COVERAGE: The Bigger Picture on Medicaid and Congress

Julie Barnes — Thu, 24 Apr 2008 16:33:00 -0400

Congress and the President are doing battle yet again about Medicaid , and NPR's Julie Rovner explained in a nice piece this week why we all should care. She illustrated a point we've made ourselves about why insurance matters: the uninsured place an additional burden on already over-taxed Emergency Departments, affecting the quality of care for all of us.

Specifically, the costs associated with uncompensated care for the uninsured and underinsured, and Medicaid underpayment cause many EDs to either close or drastically scale back the number of emergency beds. In fact, between 1993 and 2003, 425 emergency departments closed nationwide. Median ED waiting times for the insured and uninsured increased by 36% between 1997 and 2004.

Rovner drove this point home by recalling some particularly moving testimony Dr. Angela Gardner, Vice President of the American College of Emergency Physicians and an emergency doctor from Galveston, Texas, made before the House Oversight Committee last fall. If you missed Gardner's testimony, here's a must read excerpt:

I worked in the emergency department on Tuesday night, and on my arrival all 48 of my beds were full. We had 22 patients in the hallway. We had 14 patients in the waiting room. We had three ambulances unloading and two helicopters waiting to land. That is a normal day. ...

At midnight I got a patient who arrived to me comatose from the back seat of his mother's car. He had been driven 250 miles to my emergency department to get our care. I will call this man Norman to preserve his privacy. Norman had been having headaches for about a month.

On the third week, when his right hand wouldn't work any more and he started vomiting, his mother said, you have to go to the hospital. They went to the emergency department at their local hospital, where he was diagnosed with a brain tumor on the left side of his brain. ...

After waiting eight days for his bed in the hospital there in his home town, Norman, in pain and vomiting and unable to move out of that bed, begged his parents to take him home to die, and they did. He went home to die, and when he became comatose his mother loaded him in the back seat and brought him to me. I put him on a ventilator. I gave him drugs. I got him a neurosurgeon. What I could not get him was a bed....

I do not know if Norman died, but I believe that he will die in that trauma bay. He will never see the inside of a hospital. He will have his neurosurgeon, but he will not have a bed.

As you sit here and absorb the impact of the story, I would like to let you know something. Norman is not indigent. Norman is a working man with health insurance. The problem with the cuts that Medicaid wants to make, the cuts to Medicaid that are being proposed, is that it affects not only the indigent but everyone out there. This could happen to you, it could happen to someone that you love.