Print
E-mail
Share
digg
Newsvine
Facebook
Stumble
Technorati
reddit
Fark
twitterhealth:
No spendthrift, state has ballooning health care bill
Medicaid costs reveal big stakes of reform
Monday, Aug. 10, 2009 | 2 a.m.
Sun Archives
- Why some American values are obstacles to insurance system overhaul (8-6-2009)
- Hospitals wait on reform details (7-31-2009)
- Reid's secrecy on health car reform provokes frustration, admiration (7-29-2009)
- Demonstrators rally for health care reform (6-27-2009)
- Medicaid cuts compound health, economic crises (12-2-2008)
- Providers close doors to poor (11-16-2008)
- Medicaid reductions to hit hospitals (9-5-2008)
- State delaying Medicaid payouts (6-20-2008)
Sun Coverage
Few places have more at stake in the health care reform debate than Nevada.
The central aims of the reform movement pushed by President Barack Obama, congressional Democrats and a few Republicans are to extend coverage to the uninsured and stop spiking costs before they consume the entire economy.
Nowhere are those two problems more acute than in Nevada.
To wit:
Nevada has long had the nation’s stingiest Medicaid program, with some especially restrictive eligibility requirements.
In part because of the tougher eligibility standards, just 6.7 percent of the population is enrolled in Medicaid, a federal-state health insurance program for the poor. That enrollment is second lowest in the nation, according to the most recently available data.
Nevada has created eligibility rules that meet the bare minimum for receiving federal money. The program does not include optional groups such as the so-called “medically needy,” who have income well above the poverty line but have burdensome medical expenses due to chronic illness or injury.
Because Medicaid is a key method for covering the uninsured, the low enrollment rate means the state has some of the highest rates of uninsured in the nation, nearly one in five Nevadans, according to the most recent data available from the Kaiser Family Foundation.
Nevada also gets everything that accompanies high rates of the uninsured — emergency rooms packed with people who have no means of paying, and Nevadans whose lack of medical attention leads to expensive, long-term chronic illness.
“There’s long-term consequences,” said Mike Willden, director of the Nevada Health and Human Services Department. “If you put off health care, it may be more expensive down the road. If you don’t treat diabetes early on, you wind up with very expensive chronic treatment.”
Indeed, most Medicaid money is spent on chronic diseases, roughly 70 percent, Willden said.
One way Congress is considering cutting the rate of uninsured is the fairly simple step of expanding Medicaid.
This has policymakers feeling some trepidation, said Assemblywoman Sheila Leslie, D-Reno, a longtime key player on health policy and budgets. Though Congress has pledged to pay for the entirety of the new enrollment, it could just as easily shift the new costs to the states down the road.
Even without that kind of cost-shifting, Nevada is experiencing a surge of Medicaid spending despite the general flintiness of its program. The rise in unemployment, home foreclosures and personal bankruptcies has led to a sharp spike in Medicaid enrollment.
Enrollment dipped to about 170,000 in the summer of 2007 just as the local economic bubble began swiftly deflating. Medicaid enrollment has been rising swiftly ever since.
The July enrollment was 25 percent higher than two years earlier, at 215,000, already 5,000 ahead of what the Legislature forecast when it recently passed its two-year, $6.9 billion budget.
Robin Rudowitz, principal policy analyst for the Kaiser Family Foundation, said that while other states are seeing enrollment increases, the effects of the recession appear to have been more severe and more broadly felt in Nevada.
Because Medicaid consumes roughly 15 percent of the state budget, this enrollment overrun threatens to break a hole in the state budget, which has led to speculation that Gov. Jim Gibbons will call a special legislative session to fix it.
The problem cannot be easily fixed, for, as Willden noted, a condition of Nevada’s accepting $125 million in federal stimulus money for Medicaid this fiscal year was that the state could not create more restrictive eligibility requirements.
Dealing with the rising number of uninsured is just half the effort of reformers in Washington, however.
The other is finding a way to stem rapidly rising costs.
More than one in six American dollars goes to health care. And although the United States spends $6,000 per capita on health care, or often as much as double the rest of the industrialized, developed world as a percentage of our gross domestic product, those other nations often have higher life expectancies.
Costa Ricans live as long as Americans, even though that Central American country spends less than one-tenth what the United States does on health care per capita.
On this score, Nevada also has much at stake.
To begin with, rapidly rising medical costs drive up the cost of Medicaid, which takes resources from other priorities, such as improving education.
“We cannot sustain the system we have now. We can’t keep going in this direction,” Leslie said.
“We need federal reform,” she said.
Medicaid costs per eligible user in Nevada increased 20 percent from 2003 to 2008, and that was after a significant cut during 2008.
Inpatient hospital costs for Medicaid have increased 87 percent since 2000, or more than three times the rate of inflation.
Nevada’s relatively low rate of Medicaid spending compared with other states is due to its program being no-frills and limiting eligibility, and not because Nevada is a low-cost health care state, Willden said.
In fact, Nevada, despite mediocre outcomes, has some of the highest health care costs in the country, according to a recent study. Providers billed $9,527 per Medicare enrollee in 2006, 15 percent more than the national average, according to the Dartmouth Institute for Health Policy & Clinical Practice.
(Billings for Medicare, which is the government-run health insurance program for people 65 and older and the disabled, are considered a good barometer of a region’s overall health care costs.)
What is driving this cost?
Health care policy experts call it “premium utilization” — expensive tests, procedures, surgeries and medications, all of which offer questionable — and perhaps even deleterious — outcomes.
These expenditures drive up the cost of public programs such as Medicaid, but also private health insurance premiums, forcing businesses to drop coverage or forgo wage increases in the face of the premium increases.
The U.S. Senate, led by Nevada Democratic Majority Leader Harry Reid, will take up health care when it returns from the August recess next month.
Discussion: 23 comments so far…
Post a comment
- Most Read
- Discussed
- Most E-mailed
- Metro admits to improper release of criminal history data
- Wonder drug for men no success story
- CityCenter: One man’s concept of a real city
- Locomotives win inaugural UFL championship
- If Palin’s book is so bad, then why is it a best-seller?
- Was a foiled bank heist a cry for help?
- Bellfield tolls again for UNLV in 76-71 win over Louisville
- Metro corrections officer remembered for his love of family
- UNLV recalls last year’s close shave at Louisville
- Live game blog: Bellfield, UNLV come through late, upset No. 16 Louisville
Blogs
The Kats Report
If the message is 'rock out,' then KISS is indeed a message band (1 Comment)
Could a savior of shuttered Las Vegas Art Museum be ... Peter Max? (6 Comments)
For Paul Stanley and KISS, rock and roll is not over (6 Comments)
Twenty years ago today, Human Nature took root on the farm (1 Comment)
Robin Leach's Las Vegas Celebrity Watch
Photo Gallery: Donny Osmond’s triumphant return to the Flamingo
The Kats Report
'DWTS' champ Donny Osmond still deft afoot in return to Flamingo (8 Comments)
Politics: The Early Line
Meeting of GOP governors draws challengers, not Gibbons (5 Comments)
Calendar »
- 29 Sun
- 30 Mon
- 1 Tue
- 2 Wed
- 3 Thu
-
Tahoe Takeover at The Bank
The Bank | 10 p.m. to 11:59 p.m.
-
Playboy Club model search
Playboy Club | 10 p.m. to 11:59 p.m.
-
Queen of Queens at Revolution Lounge
Beatles Revolution Lounge | 10 p.m. to 11:59 p.m.
-
Zowie Bowie's Vintage Vegas Show at Monte Carlo
Lance Burton Theater
The Sun
Locally owned and independent for more than 50 years.
Clean out the garage; Grandma's moving out of the nursing home!
Why doesn't Greenspun just let the Democrats write his articles? Could save on reporter's salaries.
...Econ 101...c'mon people, we all know why it is operating at a deficit...simple...ask yourself how much of something will you 'buy' if the direct cost to you is nothing?...there are millennia of experience, statistics, and understanding of human nature, yet politicians refuse to adjust in a beneficial manner...
rejco100
LOLOLOL That was good! I like starting my week off with a laugh instead of a downer!!!
PS And it is not so far off of being reality!! Besides nursing homes are awful. I'm sure they are worse here then most places.
What also drives up costs are the hundreds upon thousands of illegals who use emergency rooms for primary care. They aren't even here legally and they want to extend coverage to the uninsured. If you deported all the people who weigh on our health care system we would all be better off.
I don't think there is an example of government programs ever controlling their costs effectively. If Nevada had expanded these programs in the past we would be in a worse situation today with our legislators demanding an even bigger tax increase (and we just got done with what looks like the nations largest tax increase).
There are effective alternatives. We can always:
1) Reduce and or eliminate insurance mandates. Nevada has 53, each one requires us to buy a service we may not want or need which increases the price.
2) Allow insurance companies to create bare bones policies so the poor can afford health insurance
3) Eliminate restrictions on health insurance competition by allowing individuals to buy out of state policies
4) STOP TAXING insurance policies
5) Encourage health savings accounts (the third party payer system is a big part of the problem and a government take over won't change that)
It's morally wrong to leave 100 million Americans un or underinsured, 1 illness away from financial ruin. And it's wrong to burden small business with the outrageous insurance costs also -- found a cool site; Balkingpoints ; incredible satellite view of earth
This is a shill game. Medicare and the State PUBLIC health care programs are broke so there has to be an increase in taxes. Taking over an industry that is 17% of the economy and appropriating the "profits" of the insurance companies is a huge tax windfall.
Will care get better? I would point to the State Run Mental Hospitals that were closed in the 1980's. There will be patients in urine soaked beds with the Sun blaring headlines.."our senior care" while the government whines.."We can fix this..with higher taxes.
The Federal Highway Trust Fund and SS were sucked into the General Fund ..and now the sucking sound is getting louder..Health care will not improve..and every administration will rewrite all the rules and regulations..and that will get to be a stanglehold on medicine.
I support my local newspaper. I subscribe and since I recently became a registered voter in Nevada I have been reading the Sun.
I find the reporting so biased that I have decided not to subscribe.
Reg,
Some of the 47 million uninsured have access to government programs already. Some of them could afford a policy but have chosen not to buy one.
The only thing Obama care does is provide a subsidized public option and then put a gun to people's head telling them to buy coverage or face a $1,000 a year penalty. So"how does kicking the poor when their down actually help them out?
Patrick_R_Gibbons, how does one get a job where the job description consists entirely of posting the same illogical comments on newspaper and blog websites every day, over and over? I mean, all that Nevada teachers, firefighters, and the police need to do is quit, sit on their duffs and repeat stupid tropes all day make a good living. Right? Tell us, Gibbons, who pays your salary? Inquiring minds want to copy.
Actually teachers and firefighters certainly do get on here (especially on the RJ) and post their opinions. Do you not recall all the debates over the budget?
Also, how are my comments illogical? Are you being lazy or do you have proof? I'd be happy to debate you but I don't prefer the intellectual laziness of ad-hom attacks.
No to ObamaCare.
Yes to: Tort reform, to reduce practitioner liability costs; encourage private insurance to incentivize "outcome based" care; free immunizations & annual exams for minors, billed to MediCare; mandate uniform data standards & allow cross state policies to facilitate transportability & increase competition.
And immigration reform, Real ID, and e-Verify need to be part of the discussion. The American taxpayer can't subsidize medical care to everyone in Mexico along with everyone in this country -- it's just too much. Eliminate the illegals and "don't want insurance but can afford it" from the equation, and relatively more affordable changes to expand coverage may be be possible under MediCare.
"Nevada also gets everything that accompanies high rates of the uninsured -- emergency rooms packed with people who have no means of paying, and Nevadans whose lack of medical attention leads to expensive, long-term chronic illness."
Pure BS.....Nevada emergency rooms are no worse or better than states that have liberal medicaid requirements and that goes the same for lack of medical attention that leads to expensive, long-term chronic illness.
This is just the personal opinion of the writer who is lazy and just repeating crap that he heard over drinks with his lib koolaid pals.
If you are make lazy unproven statements like this then at least do one those bogus "unnamed" sources thingy.
This is just a silly story.
Gee Patrick what is a "bare bones" insurance policy? You always want to engage in logic so present the facts of what a "bare bones" policy is. I suspect that it will have extremely high deductibles. So a 60 year old who has a chonic condition buy a "bare bones" policy with a 10K deductible. This person develops a medical condition which forces him into a hospital for 3 days. They still have to come up with 10K How many "poor people" have 10K? This is just one example of a problem with your simplistic sound bites that really fail to address the whole problem. How many insurance companies will want to write a policy for a "poor person" who has a chonic illness? Hopefully you will never have to be in this situation but the karma troll can really bring introsepction.
Why on earth would a bare bones policy have a 10k deductible?
Right now Nevadans MUST BUY an insurance policy covering at LEAST 53 different things. Like drug abuse counciling....I don't use drugs and never will. Why on earth should I have to pay for that?
Or alcoholism treatment?
Or acupuncture?
Bare bones would be up to the legislature to decide but it should be a minimum coverage that has much less than 53 mandates.
Better yet, just get rid of the mandates let insurance companies sell what people are willing to buy.
and seriously Jbond, your justification for a universal health care system is on the rare instances of someone having to be old, poor, and with chronic illnesses?
I mean give me a break. You want to treat everyone the same to take care of rare events? You couldn't have a more shaky foundation for a political position.
This is what I call the "One-armed crack addicted mother with 8 children fallacy" This was an ACTUAL excuse presented to me by a fellow PHD student in college who opposed school vouchers on the grounds that a one-armed crack addicted mother might not make a choice for her kids and thus leave them in a failing school. Because of this exception he reasoned there must be a universal government monopoly on education.
This is just an utterly bizarre and fallacious foundation.
The smart answer, if you are going to have a government program, is to manage the exceptions to the rules not manage everyone as if they were the exception.
If we should have social safety nets, you have them for the rare instances of the needy poor not for every freaking person. If you need health care coverage for the poor you provide health care coverage for the poor, not for every freaking person. And the provision of these social services DOES NOT have to be done by a government monopoly.
If it is a good thing to run these programs why does the left insist on running these programs in the worst way possible?
Don't avoid the question, Patrick_R_Gibbons. Who pays your salary? I know that it is part of your job to post on here. We'd all like to get on that gravy train.
Better yet, if the poor need food, clothing, healthcare, shelter....just give them the money. Let them decide what is best for themselves and their families rather than building a massive unresponsive and unaccountable government bureaucracy which will suck up 50% of the funds to maintain its own existence.
If the poor need help, just give them the money.
bremskraft,
I don't know what school you went to but there are rules to debate. Ad-hom attacks and straw men avoid debate, they don't help you win.
Easy solution.. get rids of illegal mexicans!
Here's another problem that Nevada is facing: things are getting so bad in Calif. that more illegals are going to flock to Nevada and Arizona. Tuition at Cal-State LA just went up 30% and LAUSD (los angeles unified school district) also received some super colossal budget cuts. Maybe you better start an ad campaign to tell illegals NOT to come to Nevada, because they have nothing to look forward to in your state.
Darling Patrick:
I was attempting to use realistic numbers rather than participate in your fantasy land health insurance policy. What would a bare bones policy deductible be since you are obviously so much more intelligent? Please do not confuse mandates with deductibles. Lets see your proposal with actual numbers rather than seeing your endless verbal fluff. Young people can have chonic conditions as well we don't have to focus exclusively on age, lets see your specific bare bones policy for all groups since you insist this is the way to go.
I am not advocating that government is the only way to go but obviously the private sector insurance has not done such a bang up job or we would not be having this dicussion would we?
Patrick attempt to remain calm and respond without the vingar of government is the all evil and show us how your research puts together an insurance policy that is affordable yet protect people from going bankrupt and use real numbers.
Show us how your employer gives money to the poor and how much more efficient you are distributing money to the poor.