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Read the rules in the OP before posting, please.In order to ensure that this thread continues to meet TL standards and follows the proper guidelines, we will be enforcing the rules in the OP more strictly. Be sure to give them a re-read to refresh your memory! The vast majority of you are contributing in a healthy way, keep it up! NOTE: When providing a source, explain why you feel it is relevant and what purpose it adds to the discussion if it's not obvious. Also take note that unsubstantiated tweets/posts meant only to rekindle old arguments can result in a mod action. |
Btw the Washington Post has a great article comparing the ACA vs the Senate bill vs the House bill on major issues. Id link but on phone.
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On June 23 2017 04:00 On_Slaught wrote:
From what I've seen pre-existing conditions are being untouched and must be covered. I suppose the question to Buckyman is what do you grade the requirement that pre existing conditions must be covered, if correct?
I was only grading changes. Grading the pre-existing condition mandate would require an alternative policy to compare it to.
My general read on the mandate is that it may be defensible for risk-pool schemes (HMO style) but shouldn't apply to certain more traditional products (e.g. catastrophic coverage).
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United States43814 Posts
The whole healthcare debate is essentially people going "I like the way that sick people get healthcare for less than it costs to provide, I just wish I wasn't forced to buy this expensive health insurance because I'm healthy and don't need to be paying this much" and the Republicans insisting that they could have their cake and eat it too.
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On June 23 2017 04:13 Nevuk wrote:
The bill is already mostly dead. It won't even see a vote in its current form as it has lost 4 votes already.
Also listening to conservative talk radio at the moment and they aren't happy with it.
That is what happens when you decide to go it alone. Maybe they can craft a bill that isn’t garbage and pass it with 60 votes as intended.
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United States43814 Posts
On June 23 2017 04:17 Buckyman wrote:
I was only grading changes. Grading the pre-existing condition mandate would require an alternative policy to compare it to.
My general read on the mandate is that it may be defensible for risk-pool schemes (HMO style) but shouldn't apply to certain more traditional products (e.g. catastrophic coverage).
I don't think you're getting it. Removing the individual mandate removes the whole thing. That's where the money comes from. Without the individual mandate there is no money and without any money there is no healthcare plan at all.
You cannot isolate the individual mandate, no more than you can isolate taxes as a government policy you disapprove of.
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On June 23 2017 04:17 Buckyman wrote:
I was only grading changes. Grading the pre-existing condition mandate would require an alternative policy to compare it to.
My general read on the mandate is that it may be defensible for risk-pool schemes (HMO style) but shouldn't apply to certain more traditional products (e.g. catastrophic coverage).
Just compare it against the house bill which makes it waiverable into high risk pools. These high risk pools some want are destined to death spiral. The Senate bill actually decreases the money available to mitigate the money loss relative to the house one.
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On June 23 2017 04:20 KwarK wrote:
You cannot isolate the individual mandate, no more than you can isolate taxes as a government policy you disapprove of.
First things first: The individual mandate doesn't affect the total cost paid by consumers, excluding the noncompliance penalties paid to the federal government. Agree/disagree?
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On June 23 2017 04:23 Buckyman wrote:
First things first: The individual mandate doesn't affect the total cost paid by consumers, excluding the noncompliance penalties paid to the federal government. Agree/disagree?
Disagree, though it may not be immediately apparent.
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repeat after me: the ACA is a three legged stool
also, reminder that individual/ small group coverage was complete garbage and getting worse prior to the ACA
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On June 23 2017 03:24 Plansix wrote:Show nested quote +On June 23 2017 03:13 Danglars wrote:On June 23 2017 02:26 Plansix wrote:On June 23 2017 02:25 ticklishmusic wrote:
i don't feel too much w/r/t to pelosi. she's okay. an adequate minority leader, and a survivor. i wouldn't be surprised to see her as speaker again honestly, but there's definitely young blood in the dem caucus that is a couple years away from taking leadership. After the Bush administration, I felt it was a bit much for the Democrats to install one of their most disliked members in leadership in 2008. I was as pissed as anyone else after Bush, but it just seemed petty and spiteful. I felt the same about Rahm Emanuel as chief of staff. Especially when their first plan was to pass a bill that they wanted Republican buy in on. Rahm Emanuel at least has his head screwed on right on the Democrat party's future. Mayor Rahm Emanuel has warned Democrats they need to "take a chill pill" and realize that they are not going to take back national power anytime soon.
"It ain't gonna happen in 2018," Emanuel said Monday at Stanford's Graduate School of Business in California. "Take a chill pill, man. You gotta be in this for the long haul."
As he did last month at an event in Washington, D.C., the mayor expanded on what he believes is the road map back to power for his party — putting moderate candidates such as veterans, football players, sheriffs and business people up in Republican districts, picking battles with Republicans, exploiting wedges within the GOP and fighting attempts to redistrict Congress on partisan grounds.
But this time he didn't hold back on his frustration with some of his fellow Democrats.
"Winning's everything," he said. "If you don't win, you can't make the public policy. I say that because it is hard for people in our party to accept that principle. Sometimes, you've just got to win, OK? Our party likes to be right, even if they lose."
He added, "I don't go to moral victory speeches. I can't stand them. I've never lost an election. It's about winning, because if you win you then have the power to go do what has to get done.
"If you lose, you can write the book about what happened — great, that's really exciting!" he said, sarcastically.
Instead, he said, Democrats should focus on the GOP. "Wherever there's a disagreement among Republicans, I'm for one of those disagreements," he said. "I'm all for it. The president's with Russia? I'm with John McCain and Lindsey Graham, I'm for NATO! Why? (It's a) wedge. Wedges have to be schisms, schisms have to be divides." Chicago TribuneAsked by CNN’s Dana Bash to explain that comment, the Chicago mayor on Sunday criticized the Washington groupthink of making elections “only about Congress” rather than across the state and local level.
Over the past eight years, Democrats went from holding a majority of governor’s mansions to seeing Republicans hold 33 of them. Republicans have complete control of 32 state legislatures, while Democrats control 12 and six are divided.
“You have to have a long horizon, obviously, and work towards that — electing people at the local level, state houses, into Congress,” Emanuel said, declining to predict whether this generation of House Democrats could replicate what happened in 2006.
“Do I think we’re going to have a good year in 2018? Yes. Do I think everything’s going to be solved in a single cycle? That’s not how we got here, and it’s not going to be how we get out.” WaPoThings like DNC chief Perez attacking moderate Democrat positions right before elections will just keep them out of power. Keep Dems with a message appealing to certain elements of the left wing, but keep Republican districts in Republican hands. Rahm Emanuel is also hated by parts of the city he is mayor, specifically the black parts. But he does talk a good talk, even if he doesn’t often back it up when it comes to policy or governing. He is the dude who tells black people to calm down while running a city whose police force was operating an off the books detention center.
So he makes an important strategic argument that major Democrats have missed, but fails when he gets into the job of governing. I'm surprisingly content with a somewhat gifted strategist good at chief of staff lieutenant duties falling short in gubernatorial or executive duties.
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On June 23 2017 04:24 Nevuk wrote:Show nested quote +On June 23 2017 04:23 Buckyman wrote:
First things first: The individual mandate doesn't affect the total cost paid by consumers, excluding the noncompliance penalties paid to the federal government. Agree/disagree? Disagree, though it may not be immediately apparent.
Protections for pre-existing conditions and quality of coverage factor in. Some people were getting very cheap healthcare that was pretty much useless prior to the ACA.
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United States43814 Posts
On June 23 2017 04:23 Buckyman wrote:
First things first: The individual mandate doesn't affect the total cost paid by consumers, excluding the noncompliance penalties paid to the federal government. Agree/disagree?
Disagree.
Say you're a healthy person with average healthcare costs of $600/year. The insurer groups you in a risk pool with a diabetic with healthcare costs of $6,000/year. Then they offer each of you premiums of $275/month for insurance. You know you're pretty healthy so you think that's total bullshit. But you also know that due to the individual mandate you are legally required to buy insurance. You suck it up and you pay. Meanwhile the diabetic also pays his $275/month.
Total money going into the system $6,600/year. Total money coming out, $6,600/year. System works. It sucks for the healthy guy but it works.
Now let's scrap the individual mandate.
Healthy person says "$275/month? Fuck off" and goes without insurance. He still has $600/year in costs, he pays cash.
Unhealthy person says "$500/month? I can't afford that" and also goes without insurance. Due to not managing his illness his costs double but that's not really relevant because he's not going to pay them anyway, he's going to the emergency room for healthcare when he needs it and he's not paying the bill. Hospital rates for everyone else go up, we all pick up the tab.
Uninsured sick people do not pay their medical bills. They pass them on to the government and to the rest of society. If the uninsured person was going to pay his $6000/year in cash (and get all the preventative and management care he'd get with insurance if he was paying cash) then it'd be $6,600/year either way but if you recall how things were before the ACA, that's not how it was.
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kwark one minor note, in your example the cash-paying healthy person doesn't get negotiated rates and so ends up paying closer to $1500 or something
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On June 23 2017 04:40 IgnE wrote:
kwark one minor note, in your example the cash-paying healthy person doesn't get negotiated rates and so ends up paying closer to $1500 or something
I looked into that a few months ago; negotiations tend to favor individuals over insurers right now. I think the culprit is overhead from the insurance bureaucracy, although there are less favorable interpretations (e.g. kickbacks to the insurers paid out of premiums)
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Source
Republicans' Proposed Medicaid Cuts Would Hit Rural Patients Hard
For the hundreds of rural U.S. hospitals struggling to stay in business, health policy decisions made in Washington, D.C., this summer could make survival a lot tougher.
Since 2010, at least 79 rural hospitals have closed across the country, and nearly 700 more are at risk of closing. These hospitals serve a largely older, poorer and sicker population than most hospitals, making them particularly vulnerable to changes made to Medicaid funding.
"A lot of hospitals like [ours] could get hurt," says Kerry Noble, CEO of Pemiscot Memorial Health Systems, which runs the public hospital in Pemiscot County, one of the poorest in Missouri.
The GOP's American Health Care Act would cut Medicaid — the public insurance program for many low-income families, children and elderly Americans, as well as people with disabilities — by as much as $834 billion. The Congressional Budget Office has said that would result in 23 million more people being uninsured in the next 10 years. Even more could lose coverage under the budget proposed by President Trump, which suggests an additional $610 billion in cuts to the program.
That is a problem for small rural hospitals like Pemiscot Memorial, which depend on Medicaid. The hospital serves an agricultural county that ranks worst in Missouri for most health indicators, including premature deaths, quality of life and even adult smoking rates. Closing the county's hospital could make those much worse.
And a rural hospital closure goes beyond people losing health care. Jobs, property values and even schools can suffer. Pemiscot County already has the state's highest unemployment rate. Losing the hospital would mean losing the county's largest employer.
"It would be devastating economically," Noble says. "Our annual payrolls are around $20 million a year."
All of that weighs on Noble's mind when he ponders the hospital's future. Pemiscot's story is a lesson in how decisions made by state and federal lawmakers have put these small hospitals on the edge of collapse.
Back in 2005, things were very different. The hospital was doing well, and Noble commissioned a $16 million plan to completely overhaul the facility, which was built in 1951.
"We were going to pay for the first phase of that in cash. We didn't even need to borrow any money for it," Noble says while thumbing through the old blueprints in his office at the hospital.
But those renovations never happened. In 2005, the Missouri legislature passed sweeping cuts to Medicaid. More than 100,000 Missourians lost their health coverage, and this had an immediate impact on Pemiscot Memorial's bottom line. About 40 percent of their patients were enrolled in Medicaid at the time, and nearly half of them lost their insurance in the cuts.
Those now-uninsured patients still needed care, though, and as a public hospital, Pemiscot Memorial had to take them in.
"So we're still providing care, but we're no longer being compensated," Noble says.
And as the cost of treating the uninsured went up, the hospital's already slim margins shrunk. The hospital went into survival mode.
The Affordable Care Act was supposed to help with the problem of uncompensated care. It offered rural hospitals a potential lifeline by giving states the option to expand Medicaid to a larger segment of their populations. In Missouri, that would have covered about 300,000 people.
"It was the fundamental building block [of the ACA] that was supposed to cover low-income Americans," says Sidney Watson, a St. Louis University health law professor.
In Missouri, Kerry Noble and Pemiscot Memorial became the poster children for Medicaid expansion. In 2013, Noble went to the state capital to make the case for expansion on behalf of the hospital.
"Our facility will no longer be in existence if this expansion does not occur," Noble told a crowd at a press conference.
"Medicaid cuts are always hard to rural hospitals," Watson says. "People have less employer-sponsored coverage in rural areas and people are relying more on Medicaid and on Medicare."
But the Missouri legislature voted against expansion.
For now, the doors of Pemiscot Memorial are still open. The hospital has cut some costly programs — like obstetrics — outsourced its ambulance service and has skipped upgrades.
"People might look at us and say, 'See, you didn't need Medicaid expansion. You're still there,' " Noble says. "But how long are we going to be here if we don't get some relief?"
Relief for rural hospitals is not what is being debated in Washington right now. Under the GOP House plan, even states like Missouri that did not expand Medicaid could see tens of thousands of residents losing their Medicaid coverage.
Rural parts of America cannot economically support a hospital that delivers babies. There is no place for them to have their children in one of the richest nations on the planet.
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On June 23 2017 04:17 Buckyman wrote:Show nested quote +On June 23 2017 04:00 On_Slaught wrote:
From what I've seen pre-existing conditions are being untouched and must be covered. I suppose the question to Buckyman is what do you grade the requirement that pre existing conditions must be covered, if correct? I was only grading changes. Grading the pre-existing condition mandate would require an alternative policy to compare it to. My general read on the mandate is that it may be defensible for risk-pool schemes (HMO style) but shouldn't apply to certain more traditional products (e.g. catastrophic coverage).
it looks like a change to me.
though admittedly a non-transparent.
it's what their doing in essence, without admitting to it; or maybe they're just breaking the entire healthcare system even worse than it is, by requiring something that fundamentally can't work.
edit: nm, you mostly answered the question anyways. sloppy reading on my part.
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On June 23 2017 05:03 Plansix wrote:SourceShow nested quote +
Republicans' Proposed Medicaid Cuts Would Hit Rural Patients Hard
For the hundreds of rural U.S. hospitals struggling to stay in business, health policy decisions made in Washington, D.C., this summer could make survival a lot tougher.
Since 2010, at least 79 rural hospitals have closed across the country, and nearly 700 more are at risk of closing. These hospitals serve a largely older, poorer and sicker population than most hospitals, making them particularly vulnerable to changes made to Medicaid funding.
"A lot of hospitals like [ours] could get hurt," says Kerry Noble, CEO of Pemiscot Memorial Health Systems, which runs the public hospital in Pemiscot County, one of the poorest in Missouri.
The GOP's American Health Care Act would cut Medicaid — the public insurance program for many low-income families, children and elderly Americans, as well as people with disabilities — by as much as $834 billion. The Congressional Budget Office has said that would result in 23 million more people being uninsured in the next 10 years. Even more could lose coverage under the budget proposed by President Trump, which suggests an additional $610 billion in cuts to the program.
That is a problem for small rural hospitals like Pemiscot Memorial, which depend on Medicaid. The hospital serves an agricultural county that ranks worst in Missouri for most health indicators, including premature deaths, quality of life and even adult smoking rates. Closing the county's hospital could make those much worse.
And a rural hospital closure goes beyond people losing health care. Jobs, property values and even schools can suffer. Pemiscot County already has the state's highest unemployment rate. Losing the hospital would mean losing the county's largest employer.
"It would be devastating economically," Noble says. "Our annual payrolls are around $20 million a year."
All of that weighs on Noble's mind when he ponders the hospital's future. Pemiscot's story is a lesson in how decisions made by state and federal lawmakers have put these small hospitals on the edge of collapse.
Back in 2005, things were very different. The hospital was doing well, and Noble commissioned a $16 million plan to completely overhaul the facility, which was built in 1951.
"We were going to pay for the first phase of that in cash. We didn't even need to borrow any money for it," Noble says while thumbing through the old blueprints in his office at the hospital.
But those renovations never happened. In 2005, the Missouri legislature passed sweeping cuts to Medicaid. More than 100,000 Missourians lost their health coverage, and this had an immediate impact on Pemiscot Memorial's bottom line. About 40 percent of their patients were enrolled in Medicaid at the time, and nearly half of them lost their insurance in the cuts.
Those now-uninsured patients still needed care, though, and as a public hospital, Pemiscot Memorial had to take them in.
"So we're still providing care, but we're no longer being compensated," Noble says.
And as the cost of treating the uninsured went up, the hospital's already slim margins shrunk. The hospital went into survival mode.
The Affordable Care Act was supposed to help with the problem of uncompensated care. It offered rural hospitals a potential lifeline by giving states the option to expand Medicaid to a larger segment of their populations. In Missouri, that would have covered about 300,000 people.
"It was the fundamental building block [of the ACA] that was supposed to cover low-income Americans," says Sidney Watson, a St. Louis University health law professor.
In Missouri, Kerry Noble and Pemiscot Memorial became the poster children for Medicaid expansion. In 2013, Noble went to the state capital to make the case for expansion on behalf of the hospital.
"Our facility will no longer be in existence if this expansion does not occur," Noble told a crowd at a press conference.
"Medicaid cuts are always hard to rural hospitals," Watson says. "People have less employer-sponsored coverage in rural areas and people are relying more on Medicaid and on Medicare."
But the Missouri legislature voted against expansion.
For now, the doors of Pemiscot Memorial are still open. The hospital has cut some costly programs — like obstetrics — outsourced its ambulance service and has skipped upgrades.
"People might look at us and say, 'See, you didn't need Medicaid expansion. You're still there,' " Noble says. "But how long are we going to be here if we don't get some relief?"
Relief for rural hospitals is not what is being debated in Washington right now. Under the GOP House plan, even states like Missouri that did not expand Medicaid could see tens of thousands of residents losing their Medicaid coverage.
Rural parts of America cannot economically support a hospital that delivers babies. There is no place for them to have their children in one of the richest nations on the planet.
Don't blame Republican voters - their concerns have been heard.
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On June 23 2017 05:13 Doodsmack wrote:Show nested quote +On June 23 2017 05:03 Plansix wrote:Source
Republicans' Proposed Medicaid Cuts Would Hit Rural Patients Hard
For the hundreds of rural U.S. hospitals struggling to stay in business, health policy decisions made in Washington, D.C., this summer could make survival a lot tougher.
Since 2010, at least 79 rural hospitals have closed across the country, and nearly 700 more are at risk of closing. These hospitals serve a largely older, poorer and sicker population than most hospitals, making them particularly vulnerable to changes made to Medicaid funding.
"A lot of hospitals like [ours] could get hurt," says Kerry Noble, CEO of Pemiscot Memorial Health Systems, which runs the public hospital in Pemiscot County, one of the poorest in Missouri.
The GOP's American Health Care Act would cut Medicaid — the public insurance program for many low-income families, children and elderly Americans, as well as people with disabilities — by as much as $834 billion. The Congressional Budget Office has said that would result in 23 million more people being uninsured in the next 10 years. Even more could lose coverage under the budget proposed by President Trump, which suggests an additional $610 billion in cuts to the program.
That is a problem for small rural hospitals like Pemiscot Memorial, which depend on Medicaid. The hospital serves an agricultural county that ranks worst in Missouri for most health indicators, including premature deaths, quality of life and even adult smoking rates. Closing the county's hospital could make those much worse.
And a rural hospital closure goes beyond people losing health care. Jobs, property values and even schools can suffer. Pemiscot County already has the state's highest unemployment rate. Losing the hospital would mean losing the county's largest employer.
"It would be devastating economically," Noble says. "Our annual payrolls are around $20 million a year."
All of that weighs on Noble's mind when he ponders the hospital's future. Pemiscot's story is a lesson in how decisions made by state and federal lawmakers have put these small hospitals on the edge of collapse.
Back in 2005, things were very different. The hospital was doing well, and Noble commissioned a $16 million plan to completely overhaul the facility, which was built in 1951.
"We were going to pay for the first phase of that in cash. We didn't even need to borrow any money for it," Noble says while thumbing through the old blueprints in his office at the hospital.
But those renovations never happened. In 2005, the Missouri legislature passed sweeping cuts to Medicaid. More than 100,000 Missourians lost their health coverage, and this had an immediate impact on Pemiscot Memorial's bottom line. About 40 percent of their patients were enrolled in Medicaid at the time, and nearly half of them lost their insurance in the cuts.
Those now-uninsured patients still needed care, though, and as a public hospital, Pemiscot Memorial had to take them in.
"So we're still providing care, but we're no longer being compensated," Noble says.
And as the cost of treating the uninsured went up, the hospital's already slim margins shrunk. The hospital went into survival mode.
The Affordable Care Act was supposed to help with the problem of uncompensated care. It offered rural hospitals a potential lifeline by giving states the option to expand Medicaid to a larger segment of their populations. In Missouri, that would have covered about 300,000 people.
"It was the fundamental building block [of the ACA] that was supposed to cover low-income Americans," says Sidney Watson, a St. Louis University health law professor.
In Missouri, Kerry Noble and Pemiscot Memorial became the poster children for Medicaid expansion. In 2013, Noble went to the state capital to make the case for expansion on behalf of the hospital.
"Our facility will no longer be in existence if this expansion does not occur," Noble told a crowd at a press conference.
"Medicaid cuts are always hard to rural hospitals," Watson says. "People have less employer-sponsored coverage in rural areas and people are relying more on Medicaid and on Medicare."
But the Missouri legislature voted against expansion.
For now, the doors of Pemiscot Memorial are still open. The hospital has cut some costly programs — like obstetrics — outsourced its ambulance service and has skipped upgrades.
"People might look at us and say, 'See, you didn't need Medicaid expansion. You're still there,' " Noble says. "But how long are we going to be here if we don't get some relief?"
Relief for rural hospitals is not what is being debated in Washington right now. Under the GOP House plan, even states like Missouri that did not expand Medicaid could see tens of thousands of residents losing their Medicaid coverage.
Rural parts of America cannot economically support a hospital that delivers babies. There is no place for them to have their children in one of the richest nations on the planet. Don't blame Republican voters - their concerns have been heard.
I am not blaming Republican voters. I’ll continue to blame Republicans for caring about tax burdens for the wealthy as opposed to the rural people that need help. And for not expanding Medicaid.
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On June 23 2017 05:18 Plansix wrote:Show nested quote +On June 23 2017 05:13 Doodsmack wrote:On June 23 2017 05:03 Plansix wrote:Source
Republicans' Proposed Medicaid Cuts Would Hit Rural Patients Hard
For the hundreds of rural U.S. hospitals struggling to stay in business, health policy decisions made in Washington, D.C., this summer could make survival a lot tougher.
Since 2010, at least 79 rural hospitals have closed across the country, and nearly 700 more are at risk of closing. These hospitals serve a largely older, poorer and sicker population than most hospitals, making them particularly vulnerable to changes made to Medicaid funding.
"A lot of hospitals like [ours] could get hurt," says Kerry Noble, CEO of Pemiscot Memorial Health Systems, which runs the public hospital in Pemiscot County, one of the poorest in Missouri.
The GOP's American Health Care Act would cut Medicaid — the public insurance program for many low-income families, children and elderly Americans, as well as people with disabilities — by as much as $834 billion. The Congressional Budget Office has said that would result in 23 million more people being uninsured in the next 10 years. Even more could lose coverage under the budget proposed by President Trump, which suggests an additional $610 billion in cuts to the program.
That is a problem for small rural hospitals like Pemiscot Memorial, which depend on Medicaid. The hospital serves an agricultural county that ranks worst in Missouri for most health indicators, including premature deaths, quality of life and even adult smoking rates. Closing the county's hospital could make those much worse.
And a rural hospital closure goes beyond people losing health care. Jobs, property values and even schools can suffer. Pemiscot County already has the state's highest unemployment rate. Losing the hospital would mean losing the county's largest employer.
"It would be devastating economically," Noble says. "Our annual payrolls are around $20 million a year."
All of that weighs on Noble's mind when he ponders the hospital's future. Pemiscot's story is a lesson in how decisions made by state and federal lawmakers have put these small hospitals on the edge of collapse.
Back in 2005, things were very different. The hospital was doing well, and Noble commissioned a $16 million plan to completely overhaul the facility, which was built in 1951.
"We were going to pay for the first phase of that in cash. We didn't even need to borrow any money for it," Noble says while thumbing through the old blueprints in his office at the hospital.
But those renovations never happened. In 2005, the Missouri legislature passed sweeping cuts to Medicaid. More than 100,000 Missourians lost their health coverage, and this had an immediate impact on Pemiscot Memorial's bottom line. About 40 percent of their patients were enrolled in Medicaid at the time, and nearly half of them lost their insurance in the cuts.
Those now-uninsured patients still needed care, though, and as a public hospital, Pemiscot Memorial had to take them in.
"So we're still providing care, but we're no longer being compensated," Noble says.
And as the cost of treating the uninsured went up, the hospital's already slim margins shrunk. The hospital went into survival mode.
The Affordable Care Act was supposed to help with the problem of uncompensated care. It offered rural hospitals a potential lifeline by giving states the option to expand Medicaid to a larger segment of their populations. In Missouri, that would have covered about 300,000 people.
"It was the fundamental building block [of the ACA] that was supposed to cover low-income Americans," says Sidney Watson, a St. Louis University health law professor.
In Missouri, Kerry Noble and Pemiscot Memorial became the poster children for Medicaid expansion. In 2013, Noble went to the state capital to make the case for expansion on behalf of the hospital.
"Our facility will no longer be in existence if this expansion does not occur," Noble told a crowd at a press conference.
"Medicaid cuts are always hard to rural hospitals," Watson says. "People have less employer-sponsored coverage in rural areas and people are relying more on Medicaid and on Medicare."
But the Missouri legislature voted against expansion.
For now, the doors of Pemiscot Memorial are still open. The hospital has cut some costly programs — like obstetrics — outsourced its ambulance service and has skipped upgrades.
"People might look at us and say, 'See, you didn't need Medicaid expansion. You're still there,' " Noble says. "But how long are we going to be here if we don't get some relief?"
Relief for rural hospitals is not what is being debated in Washington right now. Under the GOP House plan, even states like Missouri that did not expand Medicaid could see tens of thousands of residents losing their Medicaid coverage.
Rural parts of America cannot economically support a hospital that delivers babies. There is no place for them to have their children in one of the richest nations on the planet. Don't blame Republican voters - their concerns have been heard. I am not blaming Republican voters. I’ll continue to blame Republicans for caring about tax burdens for the wealthy as opposed to the rural people that need help. And for not expanding Medicaid.
Can we blame Democrats for losing to them?
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On June 23 2017 04:44 Buckyman wrote:Show nested quote +On June 23 2017 04:40 IgnE wrote:
kwark one minor note, in your example the cash-paying healthy person doesn't get negotiated rates and so ends up paying closer to $1500 or something I looked into that a few months ago; negotiations tend to favor individuals over insurers right now. I think the culprit is overhead from the insurance bureaucracy, although there are less favorable interpretations (e.g. kickbacks to the insurers paid out of premiums)
And what do you think of Kwark's example? Do you see that situation as different than Kwark described?
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EPT
