Thursday, March 28, 2013

That Was Quick! Both WSJ And Huff Po Carry Updated News -- On Tennessee's Non-Expansion

I'll not belabor the point in any great detail, but Monday morning, I wrote a piece excoriating Tennessee Governor Haslam -- for failing his poorer constituents, and dragging his feet on accepting the federal money available for Medicaid expansion in his state.

Overnight, he has put forward a plan to essentially "privatize" the federally earmarked Medicaid expansion money, for his state. It must be noted that at least some of his "plan" is pure political theater, as he immediately pointed back at the federal government, as the source of his local problem -- by essentially saying Medicaid ought not be covering these poorest Tennesseeans. He seems to think being given federal money for his poorest citizens is, in some ill-defined way. . . wrong.

As both the WJS and the Huff Po note, Governor Haslam, a Republican, is seeking Mr. Obama's concurrence that he be allowed to use the Medicaid expansion money to purchase private health insurance -- in an exchange-style marketplace -- for people in Tennessee who are at or below 133 percent of the poverty line.

The trouble with Governor Haslam's latest idea is that it -- at its core -- attempts to make a profit off of providing health care to Tennessee's neediest citizens. [It is thus a bone thrown to the private health care insurance lobbyists in Tennessee, to boot!]

The central premise of HHS's Medicaid expansion is that -- at least for the poorest Americans, i.e., those eligible for Medicaid -- it may not be possible to provide adequate levels of privately-insured care, and still make a profit, at the insurance company-level. That has long been true. Then, what is highly-likely, under such a "plan" -- is continual cut-backs in levels of covered care. That is a reality he won't mention.

So, should these plans move forward -- as is the case with plans proposed in Ohio and Arkansas (also states with Republican Governors) -- Health and Human Services Secretary Sebelius would have to be very vigilant in insisting that the private coverage equal or exceed that available under Medicaid. That means no "creeping" co-pays, or well-doctor visit co-pays. In short, it will (in my experienced opinion) return these states to a "bob-and-weave" health care delivery non-system, for these states' poorest citizens.

Here is a bit of the fine Huff Po article -- do go read it all:

. . . .Haslam said during an address before a joint session of the Tennessee Legislature. . . . "I'd like to put in place a program to buy private health insurance for Tennesseans that have no other way to get it than by using the federal money."

Obama's health care law seeks to expand Medicaid to anyone earning up to 133 percent of the federal poverty level, which is $15,282 for a single person this year, but states can opt out. The chief executives of 25 states and the District of Columbia have declared their support for the Medicaid expansion, while more than a dozen Republican governors have ruled it out.

Under the health care law, the federal government will pay the full cost of enrolling these newly eligible people from 2014 through 2016, after which the share would gradually decline until it reaches 90 percent in 2022 and future years. . . .

Despite outlining his proposal, Haslam told legislators he wouldn't push them to move forward absent an OK from the Obama administration that would guarantee the state's access to new federal dollars. . . .
The good and compassionate people of Tennessee ought to demand better of their Governor -- and legislature. I will kep the readers posted on this -- as it develops. [Obviously, broader, deeper coverage would benefit Merck, and all of pharma -- but especially so, the generic drug manufacturers. That is why I follow it.]

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