Tag: Medicaid

On Social Spending, the Question Isn’t “Can We Afford It?” but “Who Will Pay?”

Mary Pat Campbell

Link:https://jacobinmag.com/2021/11/social-spending-biden-reconciliation-bill-build-back-better

Excerpt:

There are three possible answers to the question of who pays for social expenses. First, governments can pay by taxing their citizens to fund social programs. Second, employers can pay by using corporate revenues to provide employment-related benefits. Third, individuals and families can pay out of pocket, rely on unpaid labor from friends and relatives, or make do without.

For much of the twentieth century, the United States had a workable answer to the “Who pays?” question that drew on a mix of all three sources. Government provided certain social benefits like Social Security, Medicare, and public education. Aided by government tax incentives, many employers offered a wide range of benefits like health insurance and pensions, creating what political scientist Jacob Hacker refers to as a “public-private welfare regime.” And with one-third of the labor force unionized, and even nonunion employers pressured to match union-scale wages and benefits, many workers earned enough to support their families and handle the social expenses not covered by government- and employer-based programs.

….

For its part, government social spending has been uneven. Large universal programs like Medicare and Social Security have proven resistant to most retrenchment efforts, and Obamacare included a major expansion of Medicaid — though this was blocked in some Republican-dominated states. Meanwhile, more means-tested programs targeting low-income Americans have proven more vulnerable. In a context where employers have sharply cut back their commitment to providing social benefits, and individuals and their families are faced with stagnating wages, government’s response has proven inadequate.

Author(s):Barry Eidlin

Publication Date:28 Nov 2021

Publication Site: Jacobin

Nursing homes warn vaccine mandate could lead to staff shortages

Mary Pat Campbell

Link: https://thehill.com/policy/healthcare/570807-nursing-homes-warn-vaccine-mandate-could-lead-to-staff-shortages

Excerpt:

The Biden administration’s vaccination requirement is putting a squeeze on nursing homes as they try to balance protecting residents and retaining low-wage staff that have been reluctant to get the shot.

Later this month, the administration will outline a policy that requires all staff working at nursing homes to be vaccinated or risk the facilities losing federal funding.

The specifics of the policy are sparse so far, but it would effectively be a mandate for an industry that relies heavily on Medicare and Medicaid funding.https://aef67baff698e02f95a8ec2b0d53753d.safeframe.googlesyndication.com/safeframe/1-0-38/html/container.html

Only about 62 percent of nursing home and long term care facility staff are fully or partially vaccinated nationally, according to federal data compiled by the Centers for Medicare and Medicaid Services (CMS).

…..

“The biggest group of unvaccinated staff are certified nurse aides. They’re making close to minimum wage. They can make that, maybe even more, plus maybe even better benefits out in retail jobs, restaurant jobs. The vast majority of those employers are not imposing mandates,” Grabowski said.

Author(s): NATHANIEL WEIXEL

Publication Date: 4 September 2021

Publication Site: The Hill

Will States Resist Fresh Billions for Medicaid Expansion?

Mary Pat Campbell

Link: https://www.governing.com/now/Will-States-Be-Able-to-Resist-Billions-for-Medicaid-Expansion.html

Excerpt:

As part of the most recent federal stimulus, states that haven’t expanded Medicaid under the Affordable Care Act can receive additional matching funds. Rather than paying 10 percent of the cost for new recipients, they’d only have to pay 5 percent over the next two years. Additional subsidies mean they would actually cost themselves money by refusing to expand. Florida, for instance, would come out ahead by $1.25 billion, even after paying its share of expanded coverage. Still, Gov. Ron DeSantis and legislative leaders remain opposed.

….

It’s true that the 95 percent match rate will only last for two years. But plenty of states have put in place triggers that would end their expansion programs if the federal share ever dipped below 90 percent, notes Trish Riley, executive director of the National Academy for State Health Policy.

Author(s): Alan Greenblatt

Publication Date: 31 March 2021

Publication Site: Governing

Maggots, Rape and Yet Five Stars: How U.S. Ratings of Nursing Homes Mislead the Public

Mary Pat Campbell

Link: https://www.nytimes.com/2021/03/13/business/nursing-homes-ratings-medicare-covid.html

Excerpt:

Much of the information submitted to C.M.S. is wrong. Almost always, that incorrect information makes the homes seem cleaner and safer than they are.

Some nursing homes inflate their staffing levels by, for example, including employees who are on vacation. The number of patients on dangerous antipsychotic medications is frequently understated. Residents’ accidents and health problems often go unreported.

In one sign of the problems with the self-reported data, nursing homes that earn five stars for their quality of care are nearly as likely to flunk in-person inspections as to ace them. But the government rarely audits the nursing homes’ data.

Data suggest that at least some nursing homes know in advance about what are supposed to be surprise inspections. Health inspectors still routinely found problems with abuse and neglect at five-star facilities, yet they rarely deemed the infractions serious enough to merit lower ratings.

At homes whose five stars masked serious problems, residents developed bed sores so severe that their bones were exposed. Others lost the ability to move.

Author(s): Silver-Greenberg, Jessica; Gebeloff, Robert.

Publication Date: 13 March 2021

Publication Site: New York Times

Is WA Gov. Jay Inslee Single-handedly Responsible for America’s COVID Outbreak?

Mary Pat Campbell

Link: https://townhall.com/tipsheet/bethbaumann/2021/03/13/is-wa-gov-jay-inslee-single-handedly-responsible-for-americas-covid-outbreak-n2586203

Excerpt:

Washington State’s Aging and Long-Term Support Administration, which falls under the Department of Social and Health Services, directed nursing homes to accept COVID-positive patients that were no longer needing “acute care” in a hospital. The goal was to “transition” those patients to “alternative settings” 

“Our primary strategy to create capacity in acute care hospitals is working with participating patients and families to transition to nursing homes,” a March 20, 2020 memo stated. “Once in the nursing home, Home and Community Services staff will work the eligible individual and their family to transition to a permanent home and community-based setting of their choice.”

In exchange for taking in those patients, nursing home facilities would receive an additional $100 Medicare add-on for up to six months, The Post Millennial. That funding was part of two Medicaid waivers the state filed. 

Author(s): Beth Baumann

Publication Date: 13 March 2021

Publication Site: Townhall

Cuomo Killing the Disabled and the Elderly: This Time It’s Personal

Mary Pat Campbell

Link: https://marypatcampbell.substack.com/p/cuomo-killing-the-disabled-and-the

Graphic:

Excerpt:

But the other problem, of course, was that Cuomo wasn’t the only governor who sent sick people back into nursing homes. In addition to New York, there was also Michigan, California, New Jersey, and Pennsylvania.

Except it seems Cuomo was the only one who had his staff falsify data. So perhaps the others can get away with just admitting they made decisions that were very unwise.

As it is, the New York state legislature is starting an impeachment investigation, and I assume they’re not going to half-ass it like other impeachments we have heard tell of.

Author(s): Mary Pat Campbell

Publication Date: 11 March 2021

Publication Site: STUMP on Substack

County-level data on U.S. opioid distributions, demographics, healthcare supply, and healthcare access

Mary Pat Campbell

Link: https://www.sciencedirect.com/science/article/pii/S2352340921000639

Graphic:

Excerpt:

The dataset summarized in this article is a combination of several of U.S. federal data resources for the years 2006-2013, containing county-level variables for opioid pill volumes, demographics (e.g. age, race, ethnicity, income), insurance coverage, healthcare demand (e.g. inpatient and outpatient service utilization), healthcare infrastructure (e.g. number of hospital beds or hospices), and the supply of various types of healthcare providers (e.g. medical doctors, specialists, dentists, or nurse practitioners). We also include indicators for states which permitted opioid prescribing by nurse practitioners. This dataset was originally created to assist researchers in identifying which factors predict per capita opioid pill volume (PCPV) in a county, whether early state Medicaid expansions increased PCPV, and PCPV’s association with opioid-related mortality. Missing data were imputed using regression analysis and hot deck imputation. Non-imputed values are also reported.

Taken together, our data provide a new level of precision that may be leveraged by scholars, policymakers, or data journalists who are interested in studying the opioid epidemic. Researchers may use this dataset to identify patterns in opioid distribution over time and characteristics of counties or states which were disproportionately impacted by the epidemic. These data may also be joined with other sources to facilitate studies on the relationships between opioid pill volume and a wide variety of health, economic, and social outcomes.

Author(s): Kevin N. Griffith, Yevgeniy Feyman, Samantha G. Auty, Erika L. Crable, Timothy W. Levengood

Publication Date: April 2021

Publication Site: Data in Brief