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StumbleGibbons: Should Nevada reject federal Medicaid funds?
Governor’s office says opting out could save the state money
Thursday, Jan. 14, 2010 | noon
Sun Coverage
Gov. Jim Gibbons' office has asked state staff to evaluate dropping out of the federal Medicaid program, members of his administration confirmed today.
The radical proposal would drastically cut the state's health care safety net.
Stacy Woodbury, Gibbons' deputy chief of staff, said the governor's office has asked the Department of Health and Human Services to look into "opting-out" of Medicaid as a long-term way to save money.
A conservative national think tank, The Heritage Foundation, suggested in a recent report that states will begin dropping Medicaid as a way to avoid long-term costs mandated in the federal health care reform bills being debated in Congress.
The state Department of Health and Human Services has estimated that federal expansion of Medicaid would cost the state about $636 million over six years, money that Gibbons has said the state doesn't have. Gibbons has threatened to sue the federal government if the health care reform bill passes.
Woodbury said she talked to the health officials last week, and after talking with Gibbons on Monday, told Director Mike Willden "to give it a serious look."
Woodbury said the state might need to act quickly to get out of Medicaid, before the health care reform is finalized, to avoid mandates in the bill preventing states from opting out.
Woodbury said the state is not looking to leave all of the state's poor without health care. State money would "provide health care to the safety net program for the most vulnerable Nevadans, the elderly, blind and disabled," she said. Most of those on today's Medicaid would be shifted to "health care exchanges" in the reform bill, and paid for by federal subsidies instead of cost to the state.
Woodbury said she expects to have a report back as soon as the end of January, and opting out of Medicaid could be taken up in a special legislative session.
Gibbons is likely to call a special session soon to deal with the state's current budget shortfall, estimated as high as $450 million, though Woodbury said there would unlikely be any short-term budget savings from opting out of Medicaid.
"We're evaluating what it would look like, if it was legal, if it was feasible," said Ben Kieckhefer, spokesman for the state Department of Health and Human Services. "We're considering what we would still be able to do as a state with the general fund that we have. We're also evaluating the effect it would have on people as well as local governments and the health care system."
In June, the Legislature passed a Medicaid budget of $2.9 billion. Of that, $868 million was from the general fund. Almost all of the balance would come from the federal government, which would then be rejected under this proposal. The state money would still be available to provide some sort of assistance for low-income people, Kieckhefer said.
Advocates for the poor have long complained that Nevada has some of the tightest restrictions in the nation in who can access the Medicaid program.
Assemblywoman Sheila Leslie, D-Reno, said that opting out of Medicaid would likely have to go through the Democratically controlled Legislature.
"The human cost is unfathomable," she said. "We'd be locking the doors of our health care system to the poor. It's unthinkable."
She also added that at a time when Republicans complain that Nevada isn't getting more money back from the federal government, giving up $2 billion per budget cycle "doesn't make sense."
"I don't think they'll have to evaluate it for too long before they realize that losing $2 billion in federal health care dollars is a bad idea for the state," Leslie said. "I just don't understand the motivation."
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Locally owned and independent for more than 50 years.
The main thing Nevadans need to opt out of is the current Governor--after the primary, of course.
Assemblywoman Sheila Leslie, D-Reno, said that opting out of Medicaid would likely have to go through the Democratically controlled Legislature. "The human cost is unfathomable," she said. "We'd be locking the doors of our health care system to the poor. It's unthinkable."
Isn't "locking healthcare doors to the impoverished" exactly what has to be done to achieve affordability for the remaining masses?
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Doesn't it seem "unfathomable" and "unthinkable" that a County indebted for trillions continues to find ways to donate millions annually in foreign aid?
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"Spending on health and human services -- including primarily Medicaid and SCHIP -- is already the State of Nevada's second-largest expenditure category behind education. In the 2009-11 biennium, 29.4 percent of state General Fund spending is allocated in that direction. According to Health Care Financing and Policy Division Administrator Charles Duarte, spending specifically on Medicaid currently amounts to $1.5 billion annually in Nevada, with $450 million coming from the state's General Fund."
"In fact, the Heritage Foundation has estimated that Nevada could save $3.786 billion by 2019 if it were to end its participation in the Medicaid program and have no change in long-term care spending. All states together would save about $652 billion if they were to do the same."
http://npri.org/publications/why-play-ba...
http://www.heritage.org/Research/HealthC...
Be smart with the state money. Instead of offering high cost plans, require low-income individuals to purchase high deductible insurance plans. In return for purchasing their own coverage the state would provide a small yearly subsidy (again indexed based on income level) to a health savings account. That subsidy can be used to cover part of the high deductible each year, or saved over time.
Comrads !! Party Members !! Block Leaders !!
The party of NO in action as shown by the Gov. of Nevada. An actual example of ' pulling the plug on grandma !' Is this not unbelievable?
Cong. Grayson was apparently correct in saying the Republican Party wants us to die fast.
The Gov. and HonestEngineertheSenator are willing to have Nevadians simply die.
Comrads !! Vote !! Pray !! March !! Protest !! Try to hang on as long as possible !!
I thought talk radio bigots like Sean Insannity and Rush Limpbought say that Republicans and low taxes produce jobs and prosperity, how come we have such high unemployment then?
Just remember this little monkey Gibbons and what a complete moron and idiot he is next election..
Mred,
Lots of regulations, trade barriers and bad policies can also distort the economy and create high unemployment. Regulations can increase the cost of starting up or operating a business by increasing the compliance cost.
Certain taxes are also more harmful than others. For example, if you want to have a higher unemployment rate and low income levels you create a payroll tax.
Bailouts and government subsidies also distort the market creating a situation where inefficient resource wasting institutions are rewarded while efficient job creating institutions are punished.
ps, fosimo, grandma won't be thrown out. Getting rid of medicaid is a good idea on its own. But with the silly reforms coming out of congress it appears we can get rid of medicaid and the federal government will pick up the slack.
Nevada has tripled the number of people who are unemployed; have NO INCOME, and live on FOOD STAMPS ALONE.
Now this idea that hits people even harder???
Possibly it's because so many are now retired MILITARY, who have the TRICARE program (it's our secondary insurance provider) at no monthly premium cost, and our co-pay is about 50% of the actual bill.
If you want to see people leave this state to find a state that provides Medicare, watch the effects of something like this.
I think Gibbons is completely NUTS!
Isn't there a Gibbons monkey??? Do they eat nuts? Just wondering............
oldladyplayspiano,
which "Gibbons" are you referring to, Patrick or Gym?
Hey Pat,
Enlighten me.
How will these "low income" folks who buy "high deductible" plans pay the high deductible? Typically, the deductible on these policies is paid FIRST, correct? Before benefits kick in?
Fosimmons,
I do believe you are either on to something or on something. Perhaps both! Merci!
Jim Gibbons, Nevada's DEATH PANEL!
High deductible plans start as low as $60 a month. There is nothing wrong with asking for some fiscal discipline, ownership and accountability.
Did you know that manypeople in the bottom 20% of incomer earners in the country don't have a full-time job? Part of poverty is that the government's welfare program creates a poverty trap, encouraging people to take benefits over long term employment.
So could the federal government sell off it's vast land holdings in Nevada to other countries or states to make up for the lost contributions if Nevada were to drop out of the program?
Just wondering.
As if anybody could live on Nevada unemployment.
And the problem with high deductible insurance is the high deduction. Make it high enough and there's no point in having insurance in the first place. Where should we set it? $10,000? $50,000?
"High deductible plans start as low as $60 a month. There is nothing wrong with asking for some fiscal discipline, ownership and accountability." -- Patrick R Gibbons
Patrick, "asking" shouldn't be confused with "telling" or "forcing" through the implementation of mandates and subsides based upon the discrimination of one's wealth and/or income as your previous suggestion below indicated.
"Be smart with the state money. Instead of offering high cost plans, require low-income individuals to purchase high deductible insurance plans. In return for purchasing their own coverage the state would provide a small yearly subsidy (again indexed based on income level) to a health savings account. That subsidy can be used to cover part of the high deductible each year, or saved over time." -- Patrick R Gibbons
REQUIRING low-income to make purchases is a DISCRIMINATING MANDATE.
SUBSIDIZE saving accounts for the low-income is a DISCRIMINATING MANDATE.
: p
Great idea governor. Medicade was a dumb idea in the first place. Go back to county run clinics and a county hospital.
Harley,
1) they wouldn't be required to buy the high deductible plan unless they wanted the HSA subsidy.
2) We already provide low-income people with subsidies for medical care -- though a lot of it goes into funding jobs for middle class adults. I'm just saying if we are going to provide a benefit to low-income individuals then you should run a smart and efficient program, not one that creates a giant bureaucracy.
hey governor i thought u said low tax equal jobs
gmag39, I think Patrick missed what you asked. It would not be the $60 per month you questioned it would be the $2500, $3500, $5000 that would have to be paid by the policy holder BEFORE the insurance paid anything. At least that was what I thought you were asking. I also kind of wonder how the plans Patrick referred to handle this part.
Thanks, castle...
maybe NPRI is going to kick in the deductable, you know, for those less fortunate, from the "think tank" sunshine fund.
"maybe NPRI is going to kick in the deductable, you know, for those less fortunate, from the "think tank" sunshine fund."
Whose more likely to pay for the unwashed masses, gmag? Sheldon Adelson or Ensign's parents?
I mean, Ensign's parents have a history of paying money to poor people who are screwed by Republican politics...
Adelson just takes their money to pay for casinos in China so he can escape all those pesky building codes and the trappings of the minimum wage.
I'll wait for Sandoval the genius to weigh in on federal Medicaid funding. Watch the wingnuts push each other further and further from the mainstream Nevada voter.
edgewise,
I'm thinking it's going to be the "Cadillac Tax" for our friends the Ensigns and the Adelsons. That is the only way they'll pay a nickel more than they pay right now!
I know, I know. The righty's will scream "it's not fair!"
They'll whine and stomp around like little kids do when they don't get their way. But somehow, some way, the Adelsons and the Ensigns are going to have to kick in a few nickels more from their slot machine winnings for the new health care plan.
Using ghostcommander's numbers, Nevada received about $5,000.00 per person on Medicaid.
Do you know what it costs to have a stint put in place for a blocked coronary artery? A 24hr stay at the hospital for this costs over $100,000.00 (I know this from personal experience). The procedure for the stint is about $50,000 of that. The stint itself costs $6,000.
While $1,100,620,980.00 sounds like a lot, it's nothing when broken down to a per capita basis. Tell me, where does the rest of it come from? (Certainly not from Nebraska).
Using ghostcommander's numbers, the Nazis only killed two (2) Jews in their extermination camps...
"Someone just hang this looser." I think that there is a song in there somewhere...
Only the uneducated would compare this news story to the holocaust.
mrability :
For the LAST time it's spelled loser...
Conservative republicans are truely demented, deranged, and self-serving jakasxes.
They come by it naturally, and don't seem to even notice the harm they cause daily in our country.
Vote the selfish lying republicans OUT of office.
The world according to nors...
Would somebody please tell me where the "Brownshirts" are at...
Is the Kommandeur referring to the UPS men???
I wonder if Gibbons has any relatives on Medicaid?
The Senate bill would give a subsidy to low income folks and allow them to buy insurance that fits their needs. Every family has different medical issues. There is no one size fits all in the health care game. Let people get what they need and phase out Medicaid completely.
The program is lousy to begin with and very expensive.
Ghost...Hitler took power through force, murder and programs to get popular support. He promised a chicken in every pot and car in every garage (VW). He promised job creation and a restoration of entitlements and pensions during terrible economic times.
My father lived in Essen and mother in Berlin when Hitler was in power.
I don't know what Gibbons is doing but he is definitely not following Hitlers example of trying to get massive support.
Hey Hey Hey , don't worry about it He can't do it anyway, and besides the biggest embarrasment to ever occupy the Govenors mansion will be gone in the next election.
Who has more regulations? Hatti or Switzerland?
Where would you rather live? Good thing Hatti didn't have those pesky building code government regulations.
People in the NPI should move to the third world hell holes with less government.
Also, what regulations did the parking garage Don-Juan Gov 0 advocate eliminating? Getting rid of the cameras?
Is mred referring to Hatti's House of Pleasure over at Pahrump?
The only regulation that Hatti has is to charge full price to everyone except union members. They get the Harry and Barry discount...
How did he know their service rates? Experience? Does his wife know?
Just because Gibbons is looking into this does not mean it is a bad idea. Many states that generate big tax revenues are looking at this very thing because poor states will take more out of the system than they put in, causing states like Nevada to end up paying for other states' "insured" people in Medicare.
I never thought I would find myself defending Gibbons, but looking after the interests of the State of Nevada is why he was elected. This time, he's on the right track. You have to understand the situation and give the devil his due.
There is a long term budget benefit so there is no short term benefit for the state. I read through the Heritage Foundations report, there is a definite gap in coverage for individuals being covered by medicaid now and those who still wont be elligible for the the federal health plan. My bottom line how is making health care even harder to get for the people struggling going to improve the economy in Nevada? Allowing individuals who can't afford basic necesities on a regular basis the access to health care too? Individuals that were fine a year ago are in situations of needing medicaid. You can't just look at someone and know that they are struggling. How many of you debating even know someone on medicaid? I am not just talking about my 1 and 3 year old daughters. I was fine a year and two years ago. I know have my family on medicaid. Do you want my children to go with out more then they do now? Do you want me to get sick of a simple illness that could have been avoided. I die and then my girls become orphaned and their whole lives on the state budget? These actions would cause a domino effect that would be devistating. If you don't live it you don't know it. I think medicaid could be worked better and as a federal program should be controlled as that. The federal goverment throwing health care together is forcing states to look at this option because it does not take into considerations states don't have the funding. It also makes the state responsible in medicaid where as the federal goverment has no responsibility. If the health reform bill is passed as it is and states opt out of medicaid, there are people like me and my children who would be without.