HEALTH CARE:

Medicaid cuts compound health, economic crises

But some see opportunity for universal coverage if things get bad enough

Tuesday, Dec. 2, 2008 | 2 a.m.

There wasn’t broad consensus for decreasing gas consumption until we started paying $4 a gallon.

Could there be a parallel with a call for universal health care, as the cost of health care grows out of the reach of many who need it?

The problem is compounding: The faltering economy is increasing the number of poor and uninsured Nevadans at the same time that the state is drastically reducing their health care coverage.

In September, Medicaid, the state’s health insurance for the poor, cut hospital reimbursement rates across the board by 5 percent. That led University Medical Center, Clark County’s only public hospital, to ditch its cancer program — and hundreds of patients who depended on it for treatment.

Some pediatric specialists suffered cuts of as much as 41 percent, causing them to stop accepting new Medicaid patients. That means low-income children with bone and spine problems, for instance, may now need to leave Las Vegas for treatment.

The situation may soon become even worse.

Medicaid’s proposed budget for the 2010-2011 biennium includes an additional 5 percent cut to hospital reimbursements in July. In addition, the Medicaid eligibility of people who qualify for the Temporary Assistance for Needy Families program will be reduced from 24 months to 15 months. And the Nevada Check Up program, which provides low-cost health care coverage to children not covered by Medicaid, will be capped at 25,000 youngsters. The number of Nevada Check Up children may already have reached the cutoff level but it’s not known because the staff hasn’t kept up with the applications, officials say.

Chuck Duarte, administrator for the Medicaid and Check Up programs, says the situation could be even more dire if the economy continues to suffer. So far the 2010-2011 budget is based on a 14 percent overall reduction in expenses, but he has also been required to draw up scenarios for overall reductions of 24 or 34 percent. The hardest hit will be the poor, frail and elderly.

“This will affect people’s lives and livelihoods,” Duarte said.

The cutbacks to health coverage for the poor come at a time when the flagging economy causes more people to need the services. Duarte says if legislators don’t find a solution, and the situation worsens in 2010 and 2011, the state will have to eliminate almost all of its optional services and eligibility groups.

Pulling money from Medicaid takes revenue from health care providers who depend on it to run their businesses, Duarte says. In this way, the Medicaid cuts push the economy further into a downward spiral. In the long run, health care entrepreneurs will cut jobs and be “loath to reinvest” in Nevada, he worries. Other states are facing similar problems.

“You’re seeing a tipping point of a health care crisis that’s going to have an effect on the economy overall,” Duarte said.

When meeting the health care needs of the poor and uninsured is delayed, or chronic conditions go untreated, patients often require more expensive and protracted hospital stays. Thus, the cuts to health coverage for the poor will likely lead to higher long-term costs paid by everyone else, in the form of tax money spent and insurance premiums.

Nancy Menzel, an associate professor at UNLV and president-elect of the Nevada Public Health Association, says the health care crisis makes a case for universal health insurance coverage.

“It’s unprecedented because we have so many more poor people in need of health care and the so-called safety net has vanished,” Menzel said.

Moral arguments for insuring the poor may fall on deaf ears, Menzel says, but once the wealthy and insured understand how the uninsured population affects their lives, they might be more motivated to work toward universal health care.

If the homeless can’t be treated for communicable diseases, and their children go to school and infect the children of insured residents, people will pay attention, she says. And when more people who are employed become uninsured because of rising health care costs, others will take notice.

“When many people see the negative effect, that’s going to make a difference,” Menzel says.

Discussion: 3 comments so far…

By joncmac

12/2/08 at 8:47 a.m.

Suggest removal

41% cut seems kind of steep. Now assume will be higher bills for consumers, Health care is a mess. The good news is that there are many ways for people to get help and save on medical bills and prescriptions. Consumers need to be sure the medical provider is billing them correctly, they can negotiate down bills (Consumer Reports says 90% success rate), medical advocates can save money, and compare prices. I found this site had some ways that I saved on my medical bills.
http://www.needhelppayingbills.com/html/...
By Gregory

12/2/08 at 1:33 p.m.

Suggest removal

Nevada, specifically Southern Nevada, is a poster billboard for failed, acute supply side economics and unfettered markets, specifically uncontrolled growth without appropriate taxation. Regulation is not what should be at the state level, see Endoscopy Center, where I had three unprotected procedures since 2004.

You now have all those nice buildings in the Strip Corridor, and an abundance of empty residential homes and condo-hotels, but poor quality of life outside the strip corridor in areas of (1) healthcare (poor, and oftentimes employer managed, access to quality healthcare), (2) education (underpaid teachers, with less than 50 percent of new hires being retained beyond five years), and (3) transportation.
Trickle down economics worked for tip workers and the nightclub industry until the bubble burst and those in labor smart enough to save are squeaking by, or lost their home a/or job and are now exhausting those savings in a period of flight or delusion. Meanwhile, the "gated communities" are still intact, ready to pounce on new opportunties and huge profits about a year after the general economy rebounds. Who wins long term in this scenario (?) Nevada and Clark County are telling labor, it's young people, that we cannot afford you if you get sick, or there is a significant economic downturn. You are, as Barack Obama put it, "on your own", including your children in school. Nevada, like the country is getting now, needs a new generation of leadership and out of the box thinking to take the Las Vegas hospitality industry, with the best accommodation workers in the world, into a new era where prosperity and quality of life is "owned by all", not just the few. That is the challenge of the day. No gaming corporation is going to replace the work of your city, county, and state government. At some sane an equitable and smart tax structure must be put in place in NV at all levels, UNLV is going to have to rise beyond commuter school status in programs and campus development, and, here's the big one, NV citizens are going to have to make sure their elected officials stay "on message" in word and action to bring the change Las Vegas and NV must have for well into the 21st century.
By vegasdoc

12/2/08 at 6:18 p.m.

Suggest removal

UMC is cutting needed programs, yet it still provides care to illegal aliens who crowd its ER and will never pay their bills.
UMC doctors cannot refuse to see these patients; but American taxpayers and our children ultimately pay the price.

« Previous Ten Next Ten »

Live chat: Tuesday, noon PST; Chat with Krista Creelman; Problem Gambling Center executive director Krista Creelman will answer questions about gambling addiction from Las Vegas Sun readers from noon to 1 p.m. Tuesday, Nov. ... Submit question