by Linda Gorman
Gov. John Hickenlooper wants yet another expansion of Colorado Medicaid. This one will cover the more than 86,000 college students in Colorado that the Census Bureau estimates have incomes below the federal poverty level. It also will cover the unknown number of otherwise healthy single students above the poverty level who have incomes up to $15,414 a year. (Income figures do not include additional subsidies received for things like housing, child care, energy assistance and food.)
As the Hickenlooper Administration claims the expansion would enroll an additional 160,000 people, it seems that college students will be its primary beneficiaries.
Many Colorado colleges already require students to buy health coverage. But Medicaid enrollment is free and it covers everything from unnecessary emergency room visits and major surgery to over-the-counter drugs with $5 copays and no deductible. Students and their parents know a good deal when they see one.
Under the Hickenlooper plan, rational observers expect droves of students to drop their private coverage in favor of Medicaid. Since Medicaid enrollment is also open to anyone who can produce a driver’s license, photo ID or other proof of residence in Colorado, the expansion offers equal opportunity for the state’s taxpayers to pay for the health care of both in-state and out-of-state students.
The plan will cost taxpayers a bundle. Medicaid medical services premiums for the program’s least expensive adults are $3,000 a year per enrollee, according to the legislature’s Joint Budget Committee. Capitated payments (one flat fee for everyone) to regional organizations that provide mental health care will add another $278 for each adult without dependent children.
Groups that have managed care contracts with the state Medicaid program receive these payments for each person enrolled, whether services are used or not. This arrangement creates a financial incentive to encourage the state to enroll people in Medicaid regardless of need.
This may explain why people hear so little about the Colorado Indigent Care Program, a state program that already underwrites needed medical care for people who cannot afford it and are ineligible for Medicaid. It also may explain why the state continues to try to herd Medicaid recipients into managed care, even though it has admitted that managed care increases Medicaid expenditures. The Robert Wood Johnson Foundation also has concluded that Medicaid managed care does not save money.
In addition to paying for the new costs arising from the Medicaid caseload increase, Colorado taxpayers will have to make up for the tax revenues lost when people stop making payments to private insurers and start receiving benefits from the government.
Assuming that the federal government picks up the entire cost of medical service premiums for the first few years of the expansion, the Hickenlooper Administration estimates that state taxpayers will be on the hook for an additional $1.4 billion over the next 10 years. That assumption may understate the cost, given the state of the federal budget and the fact the Obama Administration has already proposed reducing federal funds.
Since increasing Colorado taxes is likely to trigger an exodus to other states with lower taxes, spending is a zero sum game. An additional $1.4 billion for the healthy college students means $1.4 billion less for expenditures on schools, roads, law enforcement and other core functions of state government.
This article originally appeared in Health Policy Solutions, January 24, 2013.
Should doctors ask patients if they own guns? Currently,bans the federal government from using patient medical records to compile a list of gun owners. But following the Newtown, CT shootings, President Obama issued an executive order clarifying that “the Affordable Care Act [ObamaCare] does not prohibit doctors asking their patients about guns in their homes.” The American Academy of Pediatrics (AAP) similarly encourages physicians to ask patients if they own firearms — in the name of protecting child safety. As a physician, I consider this advice misguided. Instead, physicians should not routinely ask patients whether they own guns, because it could compromise the integrity of the doctor-patient relationship. …
University of Chicago economics professor Steven Levitt has also warned about excessive fear mongering about gun ownership. In their best sellerFreakonomics, he and co-author Stephen Dubner note that a child is 100 times more likely to die in a swimming accident than a gun accident.
Yet the AAP does not tell parents to “NEVER bring your child to a swimming pool,” nor does it advocate “the strongest possible regulations of swimming pool ownership.” Rather, it recommends that parents supervise children around swimming pools and follow basic rules of water safety. The AAP correctly recognizes that a home swimming pool can be a genuine value to a family, provided that parents and children follow proper precautions. Similarly, a gun can be a genuine value to responsible homeowners, provided that parents and children follow proper precautions. …
A local colleague, Dr. Matthew Bowdish, has declared, “I will not undermine the Second or Fourth Amendment rights of any of my patients who are lawful gun owners. Nor will I record my patients’ gun ownership status in any medical records that could be accessed by government officials unless relevant to a specific medical issue.” This should be the credo of all freedom-loving physicians.
The idea behind health stamps is straightforward. Like food, health is generally considered a necessity. So why not treat it the same way we treat food?
We don’t segregate grocery stores into those that sell to poor customers and those that do not. Grocery stores take all comers, and they charge the same price to each of them. … The [food stamp] program allows poverty and near-poverty families to have access to the full range of food products. Because they pay market prices, food stamp families are welcome customers at every grocery outlet. Although they live with more limited budgets, food stamp families are able to make tradeoffs in grocery choices—using food stamps in a way that meets their own preferences and needs. Competition for food stamp dollars forces stores to compete on price and, unlike healthcare, the prices are transparent. Every paper contains full-page ads in which price plays a dominant role.
This proposal makes certain that the poor have the wherewithal to pay for their healthcare not by forcing them to wait or take poorer quality, but with healthcare dollars. These healthcare dollars are full dollars to providers, insuring that the poor can complete for resources with all other buyers of care.
In the Providence Journal, writes:of the
Federal officials at the Department of Health and Human Services just finalized rules governing health insurance for individuals and small businesses purchased through Obamacare’s new exchanges. The announcement brings us a step closer to a health-care system wherein spending continues to grow rapidly while basic coverage remains unaffordable.
Just look at what will be considered “Essential Health Benefits” (EHB). Starting in 2014, insurance plans must cover everything from mental-health and drug-abuse treatments to dental and vision for children — regardless of
whether patients want or need them.
Mandating such generous health plans for all will surely drive premiums through the roof. …
In Connecticut, for instance, insurance mandates account for 22 percent of premiums for group coverage and 18 percent for individual plans, according to the University of Connecticut’s Center for Public Health and Health Policy. …
Indeed, patients between ages 18 and 24 can expect their premiums to rise by roughly 45 percent. Those aged 25 to 29 will see a 35 percent jump, according to a study from Oliver Wyman, a consultancy. The same study showed that a three-to-one age band would drive half a million young Americans out of the insurance market.
Read more: Obamacare’s not-so-essential benefits.