Monday, March 22, 2010

Healthcare passed... healthcare killed?

Dan Froomkin reports that state budget cuts and caps on benefits are already undermining the health insurance reform package:

Sunday's House vote means there's a new era dawning for health insurance in this country -- but not for tens of thousands of poor children about to lose their coverage, or the hundreds of thousands of poor families about to suffer the brunt of significant Medicaid spending cuts.

That's because while the health care debate has been raging in Washington, the recession continues to rage everywhere else. And state governments across the country are dealing with massive budget shortfalls by reducing spending on the people who need it most, with health costs a chief target.

. . .

The Republican governor and state legislature of Arizona last week made national news when they eliminated the state's Children's Health Insurance Program (CHIP), eliminating coverage for nearly 47,000 low-income children.

. . .

And yet despite that, states are slashing Medicaid spending where they can -- by reducing reimbursement rates to providers and cutting or capping various benefits.

"They're not actually cutting people off but, in some cases, what they're doing is paying providers less, so it's harder for people to get the services that they need," Guyer said.

For instance, in Tennessee, Gov. Phil Bredesen is capping inpatient hospital services for most Medicaid recipients at $10,000. In Nevada, the legislature has put in place new limits on the number of diapers and bed pads available to incontinent Medicaid patients.

Yeah- the Medicaid system, intended to protect the poorest among us, will only pay $10,000 for a hospital stay in Tennessee. That can be the cost for one day in a hospital- or even for one TEST in a hospital, depending.

And with Republicans promising to use every tactic to repeal or undermine the health insurance reform bill, you can bet that more Medicaid and SCHIP cuts- or outright abolitions- are in the queue. That's why this bill is so horrible- it leaves virtually everything up to the states, the majority of which are still run by Republicans dedicated to rallying their base by seeking to destroy the safety net the Democrats are weaving with all the dexterity of knitters wearing oven mitts.

But are the supporters of the plan worried by the fact that everything they've promised relies on the good will of their sworn enemies to happen? Noooooo. In fact, they're making lists of all the stuff they say will happen immediately... which, ironically, helps reveal what WON'T happen immediately, or maybe ever.

Let's start at the top: #1: No pre-existing condition ban. For children. The overall ban on denying coverage for everyone with a pre-existing condition doesn't kick in until 2014- long after the next presidential election.

#3: Seniors will see the Medicare Part D "donut hole" closed by 50%... but not because coverage is going to be expanded. No, instead there will be tax rebates- long after the money was spent, IF the senior has it.

#5: Lifetime health insurance benefit caps are history, as of now. Annual benefit caps, though, continue until 2014.

#6: Remember #1? Well, there's a temporary high-risk government pool for pre-existing condition people... until 2014, when they'll have to rely on the state-run insurance exchanges. I'm not confident...

#7: If you get a brand-new health insurance plan now, it has to cover checkups and other preventative care. Your existing plan, however, if you have one, isn't obliged to do so until 2018- after Obama's out of office even if he wins in 2012.

#15: Fast food places have to put nutrition info and calorie count on all their menus. Including their DRIVE-THROUGH menus. Um... those things are hard enough to find stuff on ALREADY...

So... a lot of the stuff you thought you'd get now isn't coming for several years... and, even if the bill isn't repealed or overturned by the majority-conservative Supreme Court, a lot of the stuff might not come to pass AT ALL.

That's what comes of "bipartisan compromise."

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