Thread: $1.5 BILLION in Medicaid cuts and co-pays proposed by CA.

$1.5 billion in Medicaid cuts and co-pays proposed by California governor

The budget request includes a previously blocked 10% Medicaid physician pay cut that will be considered by the U.S. Supreme Court.

By Doug Trapp, amednews staff.
Jan. 28, 2011.

California Gov. Jerry Brown on Jan. 10 proposed a $127.4 billion fiscal 2012 budget with hundreds of millions in Medicaid cuts to physicians, plus limits on doctor office visits for Medicaid enrollees and a variety of new Medicaid co-payments.

"These cuts will be painful, requiring sacrifice from every sector of the state, but we have no choice," Brown said in a statement. "For 10 years, we've had budget gimmicks and tricks that pushed us deep into debt."

The state faces a $25.4 billion deficit through fiscal 2012, which ends July 1, 2012. Brown proposed eliminating $14 billion of the deficit by using tax extensions and other new revenues, and the remainder by using cuts. Some of the tax extensions would require voter approval.

Brown's proposed Medicaid cuts and revisions would save the state about $1.5 billion. The revisions pertaining to physicians include:

â–*Reducing Medicaid pay by 10% for doctors, pharmacies, home health care agencies, certain hospitals and others, saving $537 million.
â–*Limiting Medicaid enrollees to 10 covered clinic and physician visits per year, saving $196.5 million.
â–*Restricting enrollees to six prescriptions per month except for lifesaving drugs, saving $11 million.
â–*Requiring $5 co-pays for Medicaid enrollees' physician office visits, $100 co-pays for each day of inpatient hospital care, and a $50 co-pay for all visits to emergency departments, among other co-pays. Combined with other cost-sharing, this would raise $557 million.

A federal court has blocked the 10% Medicaid pay cut, originally enacted by the Schwarzenegger administration in 2008, saying it was adopted without considering its impact on patients' access to care. But in a victory for the state, the U.S. Supreme Court on Jan. 18 agreed to hear the state's appeal of the lower court ruling. Brown's proposal assumes that the high court will side with the state and allow the cuts to be reinstated.

The nonpartisan California Legislative Analyst's Office said in a Jan. 12 report on the budget proposal that there's a significant chance the high court will rule against the state. However, the office's analysis concluded that Brown's overall budget was a good starting point.

California Medical Assn. President James G. Hinsdale, MD, said his state's Medicaid rates already are the lowest in the nation. "California's health care safety net cannot sustain these drastic cuts."

CMA spokesman Andrew LaMar said Brown's proposal is just the first step of a six- to nine-month process of shaping and debating the state budget. For years, California has been unable to adopt a budget on time or with realistic funding proposals, he said. The Legislature rejected a similar Medicaid co-pay proposal by Schwarzenegger last spring. State lawmakers also did not act on the former governor's proposal in December 2010 to place limits on Medicaid utilization.

http://www.ama-assn.org/amednews/2011/0 ... sd0128.htm

Reducing Medicaid pay by 10% for doctors, pharmacies, home health care agencies, certain hospitals and others, saving $537 million

It does no good to have health insurance when you can't find a doctor to care for you. See what's coming under Obamacare.

I really would like to see what would happen to healthcare costs if medicaid and medicare were shot down and removed completely. I really believe the driving factors for high insurance cost and more so high healthcare costs come from 4 core reasons:

1. Free ER care even w/o health insurance, and often free care even when not ER treatment. Get billed later and never pay.

2. Medicaid and Medicare, why set competetive rates when the government is picking up the tab. Long as Uncle Sam pays the bill why not raise rates through the roof. If people can't get private health insurance anymore they will still get covered usually by medicaid or medicare, and when not the hospital just says ER treatment to recoup from Uncle Same anyways.

3. Healthcare liability. A doctor performs surgery and something goes wrong, hey lets sue! Lets claim everytime something doesn't go perfectly right that we're entitled to massive amounts of money. Forget that many patients lie to their doctors, forget that surgery always has risks, forget that doctors are still human and can make mistakes, forget medicine isn't perfect.

4. Health insurers aren't forced to compete, they each get their own area where at most they may realistically only have 1 competitor that they just make deals with.


I bet fix these 4 issues that the cost of healthcare and health insurance drop massively. I'm not talking about 10%, 20%, 30%. I'm talking 250-350% reductions in costs. Making it much more affordable for everyone to have health insurance and get healthcare... at least all American Citizens.

Originally Posted by ReformUSA2012

. . . 2. Medicaid and Medicare, why set competetive rates when the government is picking up the tab. Long as Uncle Sam pays the bill why not raise rates through the roof . . .

Medicare and Medicaid pay lower rates to doctors and hospitals than insurance companies.

Originally Posted by JohnDoe2

Originally Posted by ReformUSA2012

. . . 2. Medicaid and Medicare, why set competetive rates when the government is picking up the tab. Long as Uncle Sam pays the bill why not raise rates through the roof . . .

Medicare and Medicaid pay lower rates to doctors and hospitals than insurance companies.

Not really. An insurance company will investigate and make sure the charges are legit and question quentionable charges which result in hospitals not getting everything covered.

However Medicaid and Medicare just pay the bill flat out rarely ever any questions asked. Hospitals also recieve more from medication costs from medicaid and medicare to help offset the rest.

Would you rather have 1 customer that pays $1 more per transaction but causes problems. Or a customer that pays $1 less but never causes any payment problems.

Add in the fraud not just from clinics and small pharmacies but from hospitals and their doctors that is far far greater in medicaid and medicare.

Its what we get when Uncle Sam picks up the tab. Costs go up because they know if insurance doesn't cover it or people can't afford it Uncle Sam has your back. But take Uncle Sam out of the picture and allow insurance to be purchased across state lines along with removing the requirement private hospitals provide ER treatment even when can't pay and costs will start to plummet. But long as someone with deep pockets is involved prices go up.

Just keep in mind. Prices go up to as much as the payer can afford. If a payer can't afford the new price the price drops down just barely within what can be afforded. Its how every other industry works, same for healthcare.

Originally Posted by ReformUSA2012

. . . However Medicaid and Medicare just pay the bill flat out rarely ever any questions asked. . .

Not really. My quarterly Medicare statement show how much the doctor tried to bill Medicare and how much Medicare actually approved for payment. They usually pay 40 to 60 % of what the doctor billed.
The statement also show if the doctor can bill me for any part of the bill that they didn't pay, which is usually $0.