Facebook
Fark
Digg
Reddit
Stumble
Friday, Jan. 15, 2010 | 2 a.m.
Gov. Jim Gibbons
Medicaid: By the numbers
- $1,783,000,000 federal dollars make up 61.4 percent of the $2.9 billion budgeted by Nevada for the Medicaid health insurance program in 2009-11.
- The state contributes $868 million.
- The remaining $256 million comes mainly from local governments.
Sun Coverage
In the latest in a series of conservative policy initiatives released by the Republican governor, Jim Gibbons is considering whether Nevada should drop out of the federal Medicaid program, one of the cornerstone safety net programs that provide health care to the poor, disabled and elderly and that cover thousands of Nevadans.
Health and Human Services Director Mike Willden was asked to “take a serious look” at opting out of the massive federal program this week. Triggering the interest is concern about the health care reform bill being debated in Congress, said Stacy Woodbury, Gibbons’ deputy chief of staff.
The state has estimated that the federal requirement to expand Medicaid under the bill will cost Nevada $636 million from 2014 to 2019, when the 100 percent federal subsidy in the health care reform bill expires.
Woodbury says that dropping Medicaid is not as dire as it sounds, citing a report from the Heritage Foundation, a conservative think tank.
Instead of being on Medicaid, in which the state pays a portion of the costs, the poor would be eligible for federal subsidies to buy private insurance on health care exchanges. Money that had been used to fund the state’s portion of Medicaid, $868 million over the next two years, would be used to pay health care premiums for the elderly, blind and disabled, said Woodbury, who emphasized that the governor’s staff is still just looking at the option.
But others said the shift from Medicaid to federal subsidies would leave thousands of poor people without health care access.
Judith Solomon, senior fellow at the liberal think tank Center on Budget and Policy Priorities, said subsidies wouldn’t cover 100 percent of the cost of private health insurance. That would mean poor families would have to pay a portion of the premiums.
Even a seemingly small amount — $440 a year for a family of four that makes $22,000 a year — has been shown to be a major obstacle to the poor getting treatment, Solomon said. That would mean thousands of poor people without insurance would seek health care in emergency rooms and hospitals, costing taxpayers and the insured more money in the long run, she said.
“Theoretically, Medicaid is a voluntary program,” she said. “States don’t have to participate. But there’s a reason every state does. It’s a very good deal for states.”
Health care advocates and Democrats attacked Gibbons’ latest plan, which comes after a flurry of conservative proposals by the governor, who faces a tough primary fight in June.
“When I see proposals like this, I wonder if Nevada wants to continue to be a state, or fall back to be a territory,” said Jon Sasser, advocacy coordinator for statewide legal services. He predicted an increase in deaths, seniors getting kicked out of nursing homes, hospitals possibly closing and an increase in low-weight babies because of the lack of prenatal care.
Assembly Speaker Barbara Buckley, D-Las Vegas, said she sees this as Gibbons’ “feverish attempt to bolster poll numbers, hopping from idea to idea, with no thought whatsoever, no appreciation of the consequences. It’s really quite sad.”
Asked about the possibility that the federal government could pay for poor people’s health insurance, Buckley said: “I have absolutely no faith that they have researched this idea or have any idea what they’re talking about.”
Still, conservatives rallied to Gibbons, as they did when he proposed a series of aggressive education reforms last week.
Geoffrey Lawrence, a fiscal analyst for the libertarian Nevada Policy Research Institute, said increasing Medicaid costs and mandates mean the federal government is dictating to states how to spend money. Almost 30 percent of the state’s general fund is spent on Medicaid, he said.
Opting out, Lawrence said, “is probably the best response to (health care reform) from the standpoint of state government.”
Edmund Haislmaier, a senior research fellow in health policy studies at the Heritage Foundation, said the report he co-wrote is predicated on the idea that state legislators would not opt out of Medicaid if it would leave massive amounts of people without health insurance.
“We assumed, for reasons of politics or being nice people, that state lawmakers would not go in this direction if they found it would significantly adversely affect people now dependent on the program,” Haislmaier said. He wrote the paper with Dennis Smith, who was the head of the federal Medicaid program under President George W. Bush.
The conclusion of the paper is that, “If all states withdraw from Medicaid, their collective savings would be $725 billion.”
Solomon, with the Center on Budget and Policy Priorities, pointed out that the Heritage Foundation memo had been around since Dec. 1, but as far as she was aware, no other state had taken it seriously.
Jon Summers, spokesman for Senate Majority Leader Harry Reid, D-Nev., called Gibbons’ plan a “shell game” in which the uninsured would go to emergency rooms for treatment that would be paid for by taxpayers.
Future health care reform aside, Reid is trying to secure an extra $95 million to go toward the state’s Medicaid costs in the 2009-11 budget cycle.
Sun reporter Marshall Allen contributed to this story.
This is actually a really good idea for the state, although it will certainly have unintended consequences at the federal level.
The subsidies provided by health care reform for people who would otherwise qualify for Medicaid leave only a tiny bill remaining, which the state could pick up with the money saved by eliminating Medicaid. The net result should be pretty significant extra money available to the state, even if the state pays for 100% of the medical costs of everyone who previously qualified for Medicaid. Those people who were previously on Medicaid would wind up with better coverage (every penny would be paid by the state and federal government combined, and they would have full insurance instead of Medicaid) while the state would save large amounts of money.
I think it is absolutely a great idea to at least consider this as an option. If the reaction from Washington would not be unacceptable, this really is a big win for the state and those currently enrolled in Medicaid.
Last night another deal between Obama, Reid, and Pelosi on health insurance
----------------------
The excise tax on high-value insurance plans exemption is now $24,000 per family ($8500 for single).
But surprise State and local workers and UNION MEMBERS are exempted.
look at that little gibbons monkey...
trying anything to save his failed political career...
first he wants to destroy education...
now he wants to destroy health care...
and who does he pick on...
the weakest among us...
the children...
the sick...
hey jimmy boy...
you are a clown...
you are a loser...
make no mistake boys and girls...
jimmy's time in politics is near an end...
and he knows it...
and he is desperate...
he is not a leader...
it's a race to the bottom with this broken man...
sad...
truly sad...
I can't wait to vote him out. Where can I buy my bumper sticker "Anyone or anything but Gibbons"
And to think I moved here from Nebraska where I thought that only the self serving ran the state. Well I too cannot wait to vote this looser out. To bad he really does not have to worry about health insurance. To bad he is not like what twelve percent of the states workforce and unemployed and too bad he is not just barely surviving every week.
Right on Birdie and cnev!!! I think by getting rid of medicad will make thousands of people leave the state.. All the baby boomers that have homes here in NV will leave.
I definitely don't think this Governor has any understanding of who lives or feeds money into this state. Obiviously he is trying to clean house.
He wants the ol mighty glamourous where only the rich live and the mixture of families rich middle class or poor are gone. That would mean smaller school district. And old rich republicans living in this state only so he can get what he wants. Nevada would be a ghost state.
Do you all understand this isn't about kicking people off Medicaid, but moving them from Medicaid to actual health insurance plans subsidized by the federal government?
The money that would save can more than pay for the entire amount those previously on Medicaid would be expected to pay for premiums and out-of-pocket expenses (deductibles and copays). The people would be getting better coverage at the same time the state would save millions.
Well put Richard! We seem to get off track in a real big hurry. This is actually a pretty good idea, definitely worth further study.
I thought it up in a parking garage. Now give me a kiss.
It's imperative that the governor seriously examine all the ramifications of his idea. The situation is much more complex than it first appears.
By dropping the Medicaid program he'd be abondoning the people in the state who can least afford to be abandoned. The governor's idea would mean no preventive or early treatment for these adults and children, leading to people with treatable conditions showing up with life-threatening situations in the ER (even more than those who already do), and Nevada hospitals no longer being able to afford to subsidize high-cost, high-tech life-saving treatments (in order not to close the hospital completely) and thus no longer providing them (which affects all Nevadans). This would force people to either go out-of-state or go without care.
From an economic standpoint for the state it doesn't make sense because the governor would be rejecting almost $2 billion in federal health care dollars.
The governor's idea needs to be stopped in its tracks.
Brian you missed the point about the federal government providing subsidies for the poor to purchase health insurance... coverage wouldn't be lost.
The state "losing" $2 billion is unimportant as the beneficiaries of the program would still be covered.
The goal of the state is NOT to just spend money. If we can provide the same level of service, or better, at a lower cost, then great, let's do it.
attempts to move medicaid people to private insurance in other states has proven disasterous. Much less care, much higher costs, and of course the bureaucracy of insurance companies trying not to pay claims. And of course, the 1 1/2 billion dollars won't be going to Nevada's economy. 20-30% of the money will go to insurance company profits out of state. Also, the policies would be the mosty expensive, and the federal subsidies only are for the least expensive policies. Be very wary of this. Just a way to "cut govermint" and screw the needy.
If private insurance companies are being paid by federal subsidies surely this comes with a mark down. What does that mean for all the people who are employed and paying insurance through our employers. Insurance costs rise yearly as it is... I can't imagine what the costs would go to if private insurance companies are now providing insurance to all those, normally covered by medicade, at a lower price. Are we sure that the state would even pay those bills left over with "the savings" or is that just wishful thinking?
Loss of medicade combined with possibilities of fines and jail time for not being covered just seems disastrous and potentially unfair to the working lower-middle and middle class.
And I agree with poohbear on Vegas and maintaining the rich family enviornment. At least it seems so w/all the cuts in education budgets and NV now being 50 of 50 for education. Seems as if all these rich politcians who can afford better educations are trying to dumb down the rest of NV's children so their bloodlines can remain in the State Politics. Time for someone new...