Tuesday, February 26, 2013

Fwd: qotd: Impending access crisis for low-income patients

Quote-of-the-day mailing list

-------- Original Message --------
Subject: qotd: Impending access crisis for low-income patients
Date: Tue, 26 Feb 2013 09:52:39 -0800
From: Don McCanne <don@mccanne.org>
To: Quote-of-the-Day <quote-of-the-day@mccanne.org>

The New York Times
February 25, 2013
States Can Cut Back on Medicaid Payments, Administration Says
By Robert Pear

The Obama administration said Monday that states could cut Medicaid
payments to many doctors and other health care providers to hold down
costs in the program, which insures 60 million low-income people and
will soon cover many more under the new health care law.

The administration's position, set forth in a federal appeals court in
California, has broad national implications as it comes as the White
House is trying to persuade states to expand Medicaid as part of the new

In a brief filed with the United States Court of Appeals for the Ninth
Circuit, in San Francisco, federal officials defended a decision by
California to cut Medicaid payments to many providers by 10 percent.

Kathleen Sebelius, the secretary of health and human services, approved
the cuts in October 2011 after finding that beneficiaries would still
have "adequate access" to the wide range of services covered by Medicaid.

The Obama administration urged judges to uphold those cuts, which are
being challenged by patients, doctors, dentists, hospitals, pharmacists
and other health care providers in California.

Health care providers said California's payment rates were inadequate
even before the cuts. They pointed to a federal study that said,
"California stands out because of its very low Medicaid payment levels."

In an interview, Gov. Jerry Brown of California, a Democrat, said the
Medicaid cuts were essential to his efforts to dig the state out of a
budget hole.

Federal law says Medicaid rates must be "sufficient to enlist enough
providers" so that Medicaid beneficiaries have access to care at least
to the same extent as the general population in the same geographic area.

Moreover, the administration said, Congress gave states "wide
discretion" to set Medicaid rates, and courts should not second-guess
decisions by Secretary Sebelius on the adequacy of rates.

"There is no general mandate under Medicaid to reimburse providers for
all or substantially all of their costs," the administration said.



Los Angeles Times
February 25, 2013
Healthcare overhaul may threaten California's safety net
By Anna Gorman

An estimated 3 million to 4 million Californians — about 10% of the
state's population — could remain uninsured even after the healthcare
overhaul law takes full effect. The burden of their care will fall to
public hospitals, county health centers and community clinics. And those
institutions may be in jeopardy.

County health leaders and others say the national health law has had the
unintended consequence of threatening the financial stability of the
state's safety net.

And under the federal law, some of the funding that goes to safety-net
hospitals is also set to decrease.

Now, as the state scrambles to create the new healthcare infrastructure,
Gov. Jerry Brown is proposing to take back another crucial pot of money
that counties have depended on for more than two decades to care for the


Comment: California has been a leader in setting national trends in
health care financing. Two developments should have low-income patients
very concerned. California's Medicaid program is critically underfunded,
and the state is reducing payment rates by another ten percent. Also,
the state is reducing funding for local safety-net institutions which
provide critical access for low-income populations.

Perhaps the most alarming of all is the official response of the Obama
administration (in an appeals court filing): "There is no general
mandate under Medicaid to reimburse providers for all or substantially
all of their costs."

We have said over and over again that Medicaid, as a welfare program,
will never have the political support to fund it adequately. The burden
of the additional load of Medicaid patients will surely find the health
care resources strained beyond the capacity of willing providers,
especially when you consider that California already is not meeting the
costs of providing care to this vulnerable population. And the 3 to 4
million Californians who will remain uninsured will need to rely on the
safety-net institutions, though those institutions also are in jeopardy
- again because of the lack of political support for welfare programs.

If California is successful with its cruel budget trimming, it can be
anticipated that many more states will follow.

Here's an amazing fact: Low income patients do not have the money to pay
for health care. (What an intuitive stroke of genius!) What they need is
an affordable system that removes financial barriers to care while
ensuring adequate financing of our entire health care delivery system,
thereby removing health system disincentives to providing essential care
for this vulnerable population. Make that for all of us.

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