Newsflash: Hospital ER prices are Outrageous!
In a ground breaking study, researchers at Johns Hopkins University discovered hospital emergency departments overcharge. I know… Who would have thought ER prices are high? The study looked at 12,000 billing records for emergency medicine doctors nationwide.
Researchers found patients were charged 340 percent more, on average, than what Medicare pays for the same service. Charges ranged from 1 to nearly 13 times what Medicare’s fee schedule.
According to the authors:
“There are massive disparities in service costs across emergency rooms, and that price gouging is the worst for the most vulnerable populations,”
“This study adds to the growing pile of evidence that to address the huge disparities in health care, health-care pricing needs to be fairer and more transparent.”
The hospitals with the highest fees were for profit hospitals in the southeast and Midwest.
Hospital ER bill, what a joke:
The Bill: $83,000
Ryan Witten of Nyack, N.Y., was working in his garage one weekend last year when he severed his finger on a table saw. “Surprisingly, I stayed calm throughout the whole thing,” says the 54-year-old Witten, whose wife helped him pack his finger on ice and then drove him to the hospital.
Since Witten had recently gone to the emergency room for chest pains at a hospital that was out of his insurance company’s network—costing him $20,000 in out-of-pocket test fees—the Wittens drove to a different facility whose E.R. was in-network.
“We thought we had learned our lesson the last time,” he says, “but it turns out the plastic surgeon who reattached my finger was out-of-network.” So the contractor got a second dose of sticker shock when he received the bill for his emergency digit surgery: $83,000. Gulp.
What This Patient Did: After contacting his insurance company, Witten was able to convince them to cover the out-of-network surgeon at his in-network rate, since insurers will often relax pricing rules for an emergency procedure. Witten’s reduced bill: $5,000.
In Florida some hospitals have a $33,000 ER access fee!
I think everything is legal.
Emergency room physicians tend to charge 4.4 times the amounts Medicare pays. Internists only charge double what Medicare reimburses. What accounts for this disparity? I would argue there’s a good chance you will meet with your internist and have an ongoing relationship with him or her. You can also walk if the prices are too high. When you go to an ER, you have less discretion. You also have less loyalty to an ER doc.
Maybe we need special rules that govern how much can be charged for care that must be delivered under emergency conditions because there is, by definition, no opportunity to price shop. I think a limit of 125% of Medicare is reasonable.
A limit of 200% wouldn’t be bad.
ER NewsFlash: Blue Cross local yocal of Georgia, an Anthem Blue Cross company, reports NO ER money for YOU: Anthem is the nation’s second-largest health insurer, with thousands of medical professionals on its payroll. Yet its Blue Cross and Blue Shield of Georgia subsidiary has just informed its members that if they show up at the emergency room with a problem that later is deemed to have not been an emergency, their claim won’t be paid.
It’s a new wrinkle in the age-old problem of how to keep patients from showing up at the ER for just anything. But medical experts say the Georgia insurer is playing with fire. By requiring patients to self-diagnose at the risk of being stuck with a big bill, it may discourage even those with genuine emergencies from seeking necessary care. And it’s asking them to take on a task that often confounds even experienced doctors and nurses.
“Patients don’t come with a sticker on their forehead saying what the diagnosis is,” said Renee Hsia of the Institute for Health Policy Studies at UC San Francisco, who has studied the difficulty of making snap diagnoses at the ER. “We as physicians can’t always distinguish necessary from unnecessary visits.”
Blue Cross Blue Shield of Georgia, the [[only insurer]] offering individual insurance plans in 96 of the state’s 159 counties, sent letters to its enrollees in late May stating that it would refuse to cover non-emergency ER visits starting July 1.
——-you thought that was an emergency because of the blood but you and the insurance company have different definitions—–I thought everybody knew that.
http://www.latimes.com/business/hiltzik/la-fi-hiltzik-insurance-er-20170602-story.html
Got the BLUES? Being scammed? OR, do the BLUES have YOU?
NC Republican Senator raises white flag: Sen. Richard Burr (R., N.C.) said that the Senate probably won’t reach a deal to repeal and replace the Affordable Care Act when it returns from a recess next week, in a stark assessment of the party’s health-care prospects.
“It’s unlikely that we will get a health-care deal,” Mr. Burr told WXII 12 News, a North Carolina news station, on Thursday. He said that the House-passed GOP health plan was “dead on arrival,” and that “I don’t see a comprehensive health-care plan this year.”
NC Blue Cross and their 23% rate increase for 2018, because of President Trump, has a big friend in this Republican Burr!
23% rate increases a year isn’t so bad. Ask an economist like Devon. In 10 years these Tar Heels will be paying $90,000 a year per family. The bad news is their deductibles will be sky-high and they will be restricted to skinny provider networks that pay NOTHING if a patient goes out of network or has an emergency.
Politicians with no solutions, figures.
Poor, poor — PA. The poor people of Keystone State of PA have to suffer with 4 different Blue Cross insurance companies – SAD! 4 local yocals, all sweating bullets and raising rates.
—Independence Blue Cross, the market leader for Obamacare plans in the Philadelphia area, told CNBC that its rate submissions reflected guidance from Miller’s Insurance Department, and relied “on state and federal regulations as they stand today.”
But, “Given the legislative and regulatory uncertainty around health care reform, it may be necessary to reevaluate our proposed rates before they are finalized,” said Independence Blue Cross CEO Daniel Hilferty.
“As such, it is critical that the federal government commit to funding cost-sharing reductions to avoid disruption in the market and to ensure those with low and moderate incomes get the care they need,” Hilferty said.
The other insurers selling plans in Pennsylvania are Capital Blue Cross, Geisinger Health Plan, Highmark (BCBS) and UPMC Health Plan.–
The PA Insurance Commissioner Babe – Teresa Miller: That rate is sharply lower than the average rate hike of 32.5 percent that Miller signed off on for this year in an effort to avoid big financial losses by health plans.
But Miller also said that if Congress, at the behest of Trump, repeals the Obamacare rule requiring most Americans to have some form of health insurance or pay a fine, insurers would seek a rate increase of 23.3 percent statewide next year.
The Republican bill known as the American Health Care Act, which is pending in Congress, seeks to repeal that so-called individual mandate.
And if the Trump administration stops reimbursing insurers for a critical Obamacare subsidy to low-income customers, insurers would ask for rate hikes of 20.3 percent, Miller said.
But “if both changes occurred, insurers estimate they would seek an increase of 36.3 percent,” according to a statement released by Miller’s office.” —
Devon can tell you that 36% rate increases are much bigger than NC’s Little-Bitty 23% annual increases. Shoot, it won’t take long for these rates to get out of hand.
Devon can tell you that there are numbers so big they don’t have names. These Blue Cross CEOs say, “Just put a dollar sign in front of those numbers and fork it over.”
If necessity is the mother of invention
Then I’d like to find the guy who invented this
The numbers come together in some kind of 3rd dimension
A regular algebraic bliss.
Let’s start with something simple
Like one and one ain’t three
And two plus two will never get you five
There’s fractions in my subtraction
And X don’t equal Y
But my homework is bound to multiply
Math sucks (math sucks)
Math is hard!
https://www.youtube.com/watch?v=X5iaZf21R8w
Devon, if you are investing into real estate with your tax-free HSA in the State that you are going to retire in some uncomplicated people may choose TX because of no State Income Tax, but that would be wrong. I have been to Billy Bob’s way too many TIMES and TX is a place where you can make big mistakes and get into big-big trouble.
Peter Fortunato, a true patriot, SUFFERED when he paid the tax to put $2,000 in a self-directed Roth IRA in 2000. He said, “I have a problem paying taxes, I hate it.” It was like he had to vomit he hates taxes so much. Anyhoo, he has NEVER added any more to that Roth IRA and today the balance is $1 million by investing into real estate with a self directed IRA. Remember, anything you can do with an old boring taxed IRA you can do with a modern shiny tax-free HSA, plus so much more.
Peter says that is a 36% annual return. So 36% is a lot.
The question is: Tampa Bay, FL or Galveston Bay, TX?
Remember, MAMAs don’t let your sons grow up to be cowboys.
Nothing like this way out in west Texas
Galveston Bay is a whole other world
My wife’s in her room getting over her sunburn
How would Louis Lamore get me next to that girl?
She tells me her tan is the same way all over
She asks me to dance and says, [“Keep your boots on”]
She never met a number one cowboy
We rolled in the sand and drank rum until dawn
Who’s the blonde stranger”
Who entered my life”
Making me over on the moonlight
This side of Texas is all new to me
Who’s the blonde stranger who lives by the sea?
https://www.youtube.com/watch?v=QG1l0VLDb3o
Magyn Kelly, who couldn’t think of ONE Obamacare question during her TWO Presidential Debates, talk about a FRUITCAKE PC blond. Magyn Kelly is a multi-millionaire who pays NO TAXES on her employer-based health insurance and she didn’t think of asking Hillary, “Hillary, Oamacare’s “Family Glitch” lets rich fat-cats like me to get over-priced employer-based health insurance and pay no taxes. But, poorer Florida teachers’ children must buy expensive GUARANTEED ISSUE Obamacare plans with AFTER-TAX-DOLLARS. Which makes it even more expensive. Hillary, be honest with America, isn’t Obamacare a NIGHTMARE?”
Putin slams down Megyn Kelly over Trump
https://www.youtube.com/watch?v=vgB5O2wtvFE
Devon, I have friends in low places. Ben Cutler gave me the award for enrolling the 1st tax-free MSA in the Old Paris Opera in 1996. That was the night that the La Grand Hotel caught fire and my wife Pam called it down to the front desk. They kept saying to her, “Slow down.” So she just screamed, “FIRE!, FIRE!”
Cutler has held a number of key industry positions, having served as Vice-Chairman and Chairman of the Health Insurance Association of America (HIAA) and Co-Chairman of America’s Health Insurance Plans (AHIP), and has been a pioneer in the development and the marketing of consumer choice health plans.
AHIP, now co-opted by all of the Blue Cross plans, is in the news today:
–The once-powerful health insurance lobby — the same one that killed Hillarycare a generation ago and helped usher in Obamacare — can’t pick a side in the latest battle over America’s health care system.
Some major members of the sprawling trillion-dollar industry, like Humana and Cigna, have little at stake in the fight. Other insurers heavily invested in the Obamacare markets, like the regional Blue Cross Blue Shield plans, are urging Congress to fix the 2010 health law instead of shredding it. And then there’s Anthem, a rare industry voice supporting repeal.
The result is the lobby has lost influence and is now struggling to mount a unified front against Republican efforts to push through an Obamacare replacement. At the same time, the Trump administration has ignored their pleas to stabilize Obamacare’s exchanges in the short term, which could send the wobbly insurance marketplaces crashing before the GOP agrees on a health care plan.
“I’m still hoping they’ll step forward more aggressively and articulate how horrendous this plan is,” said Sen. Richard Blumenthal (D-Conn.), whose home state is the headquarters for several health insurance giants. “They know full well what the impact will be.”
Rep. Michael Burgess (R-Texas), who chairs the Energy and Commerce Committee’s health subcommittee, said officials from the main industry lobby, America’s Health Insurance Plans, never reached out to him while the House drafted an Obamacare replacement bill.– Blue Cross are done!
Well I guess I was wrong, I just don’t belong
But then, I’ve been there before
Everything’s alright, I’ll just say goodnight
And I’ll show myself to the door
I didn’t mean to cause a big scene,
Just wait ’till I finish this glass
Then sweet little baby I’ll go back to the bar
And the Blues can kiss my ass!
https://www.youtube.com/watch?v=t4X3ZRU5Ghg
The hotel has 470 rooms and 82 of them have views of the Opera House. Mine did on the top floor. You could just tell that NAZI Generals stayed in that room. Good view!
Devon, Ben Cutler has a BS from KU and MBA from Wharton. The 1st TIME I met him was at the Phoenix Open and I was running the largest agency in the USA for the company in both health insurance and life insurance. This is back in the old days when I was an insurance executive. At the meeting my Regional Sales Manager (RSM) had a STROKE because of the way Ben said hello to us (WARNING). I took that RSM, Paul, to ROME because I made Paul the #1 RSM in America from Omaha.
Devon, remember that, a 60-year-old guy can have a stroke when he is introduced to his new boss, MBA Ben Cutler. This is the perfect example of why people need HSA Life Insurance to pay for 2 years of HSA Qualifying health insurance deductibles, or $26,600 in 2018. PLUS, Paul had an elevator put in his AZ retirement home. So, that proves that a Critical Illness (CI) like heart attack, cancer or stroke can be mighty pricey.
Ben Cutler didn’t respect the Field Force. Which isn’t too smart. Ben went on and was the Key Note Speaker at the World Health Summit (WHS) but he was an idiot. The guy who trained me was 10 TIMES smarter, RJ. He could see the future. I was summoned by RJ in Nov. ’91 to Dallas to learn of the Health Insurance War (HIW) to come. A guy named Wofford was elected Senator in PA and RJ said he had a couple of bozos with sound bites that could shut down our industry. He said these bozos had no idea about how health insurance works but they have good polling and sound bites.
His campaign was run by Paul Begala and James Carville, and their dramatic success brought them to national attention.[3] The campaign was also a proving ground for many of the themes that would underlie Bill Clinton’s 1992 presidential election victory, such as the focus on the economy and health care.[3] Although Clinton ultimately chose Al Gore, Wofford was a finalist for the vice presidential nomination.[14]
Ben Cutler was no RJ. RJ was a billionaire though, which always makes a difference. RJ told us that he tells everybody that he votes Republican but he gives all the money to the Democrats.
Here is the mind of MBA Ben Cutler:What do you think happened in this country?
Well, two important things, and each one of them has only three letters: One was LSD, a chemical which is capable of turning a hippie into a yuppie, one of the most dangerous chemicals known to mankind. And the other is MBA. When people started taking MBA seriously, that was the beginning of the ruination of the American industrial society. When all decisions are based on an MBA’s concept of numerical reality, you’re in deep shit, because the only thing that can be judged as real is that which can be proved by a column of figures. And when all aesthetic decisions are turned over to these kinds of people, who use these criteria to make steering decisions for a company with no regard for people and no regard for what the product really is, and the only thing that matters is maximizing your profit, you have a problem. Because you can’t have quality then; you cannot have excellence. Quality’s expensive. I think most of these people that come from business schools have the desire to make sure everything is cheesy. That’s what happens when you do things that way.
Well, thanks to democracy, we now have a freely elected Fascist government in the United States, elected by just plain folks — same people you graduated from high school with.
Spoken by Frank Zappa.
But, Ben is a good writer when he is hosing the Florida Insurance Department with his ACA Magic.
http://www.floir.com/siteDocuments/FHIAB/MLRAffidavits92410.pdf
After looking at my $622 bill for blood work for an annual physical (Cigna negotiated price is $48), it finally dawned on me that this is about inflating receivables.
It would be the flip side of the way employers often force their employees to use up accrued vacation time in order to reduce payables. I don’t fully understand how companies benefit from these accounting gimmicks, but they obviously do.
This also explains why the billers don’t seem to be in any hurry to get paid. They maximize the “float” by letting the fictitious receivables hang around for an extended time, before finally converting them into greatly reduced revenue.
Bart, who rewards a business for having high receivables, especially when even a casual observers can see that the receivables are bogus?
Probably involves an accounting gimmick that I am not aware of.
Bob, these hospitals sell their over-priced receivables to collection jerks who will pay ten cents on the dollar. So, if the hospitals have to get $1,000 you have to say the cost was $10,000. Then these collection jerks put the patient’s phone number in their computer and they are called every hour for the rest of their lives.
The big problem is you have multiple medical providers when you get sick, or have a baby like I did, and all of them are selling your over-priced receivables to collection jerks who are shoving your phone number into their never sleeping computers for calling and mailing.
thanks for the insight. One of the very few virtues of a single payer system is that assumedly it would get rid of the bottom-feeding medical collections industry.
However there should be less drastic means to regulate medical collections. One method proposed in a recent issue of the Federalist was to have the government lend a patient money to pay their overdue bills. The patient would then forfeit all future refunds, et al until their debt to the government was paid down.
“One of the very few virtues of a single payer system is that assumedly it would get rid of the bottom-feeding medical collections industry.”
Would it? Do you think a single payer system will pay every bill a person assumes should be paid by the single payer insurer? There will always be some costs so collections will always be a necessity unless one wishes to go out of business.
You might feel that the collection industry is made up of bottom feeders, which may or may not be true, but would you prefer the experts caring for you to reduce your time and care so they can get to the business of collecting their own unpaid bills?
good points as always, Allan. My understanding (which may be wrong) is that Canada does not allow balance billing, therefore no collections needed.
England and Germany allow concierge medical practices, but I assume that persons who sign up for these services are affluent enough to pay each bill in advance, or at the time of service.
There is a conflict between the desire to have medicine be a kind of gift relationship, with no money changing hands at the time of service, versus the practical realities of running a practice and meeting the payroll for staff, rent, etc.
I remember seeing a chiropractor for five or six treatments and just showing my insurance card. I suspected my policy did not actually cover him (this was in 1987), but did nothing about it. After the sxith visit he asked me for a check.
I walked out and never went back.
I as a person much prefer the traditional HMO model, where a monthly payment is sufficient. Others can of course prefer cash at the time of service.
“Canada does not allow balance billing”
Bob, what I find amazing is that so many Americans believe we should be just like Canada and want a healthcare program that is identical in every state (just like in Canada). However, even though Canada’s total population is less than the population of California, the central government hasn’t made the delivery of healthcare identical in all of its 10 provinces (plus a few territories) so some of the provinces permit balance billing and some don’t. It is also amazing how many people argue in favor of things they know so little about.
Of course I recognize your preference might be different for you say that “I as a person much prefer the traditional HMO model” I believe all modalities of care should be permitted and that you should have any choice you wish, but do you really understand the principles behind the HMO? One local HMO in my area had the motto, “Delay in treatment means profit.”. Many HMO’s made a lot of profit in denying care and that is demonstrated by the suits filed against them along with a whole host of other things.
In any event who should collect the balance bills in Canada where the patient hasn’t paid? You make the assumption that affluent people easily part with their money. That isn’t true for everyone whether rich or poor so the disgusting matter of money changing hands exists. It really isn’t disgusting rather it is the way things work and that exchange of money makes things work a lot better.
Allan, I think I know what Bob means. HMO used to mean ZERO deductible. It doesn’t anymore but I’m sure that Bob is stuck in the pea-pickin’-past and just doesn’t want to pay for anything regardless if he gets good service or not.
Who in their right mind would want an HMO that pays NOTHING when a non-network medical provider is used for a serious illness like cancer?
As you say Bob is probably referring to Medicare HMO’s, but even some of the original Medicare HMO’s had additional payments required. What he doesn’t recognize is how the HMO’s cost the Medicare program a lot of money. Originally Medicare HMO’s were supposed to be paid a per capita rate of 95% of the Medicare rate. The GAO belatedly discovered (over a decade later), that when risk adjusted, Medicare HMO’s should have been paid about 1/3 less. Medicare lost money and blamed traditional Medicare for the higher costs. That is what happens when one uses someone else’s money.
This wasn’t news to many economists or others in the field. I could see that the healthiest patients were joining the HMO’s and the sickest staying on Medicare. In fact the HMO’s and doctors had similar incentives to make sure that happened. Doctors knew which patients of theirs generated high Medicare payments and which may have been seen only once in a year. HMO’s in a manner colluded with physicians when they took over a physician’s patients and paid the physician a capitated rate.
Here is a defense of the “no money changing hands at the point of service” philosophy.
https://newrepublic.com/article/143096/medical-bills-harm-us
It is written by a doctor who I believe spends most of his time teaching at Harvard, rather than running a practice.
So there are some naïve assertions.
I certainly agree with his viewpoint on ambulances, though. Ambulance service should be part of the fire department, paid for by taxes.
“Here is a defense of the “no money changing hands…” … “there are some naïve assertions.”
Why would anyone want to prove their case with naive assertions?
“Ambulance service should be part of the fire department, paid for by taxes.”
In some places they are. In other places the voters have not voted for such care. Don’t you believe in democracy?
Fernandez was born in Manzanillo, Cuba, the elder of two children of Lieba Fernandez and Mario Antonio Fernandez.
Fernandez is a Republican donor. In 2016, the New York Times wrote that Fernandez was “one of the most prolific donors in a key swing state” (Florida), contributing more than $4 million to Republicans in recent elections.
Florida’s next Governor? He has $100 million to spend!
The good news is he can’t be President. He hates President Trump. Fernandez is a Jeb Bush guy.
FAKE Republican Alert: This billionaire running for Governor in Florida, as a REPUBLICAN, gave millions to Hillary and took out full page ads, all across America, against President Trump. He made millions selling Medicaid & Medicare DUEL ELIGIBLE managed-care companies to Anthem Blue Cross. Sounds too unbelievable but it’s true. YOU can’t make this stuff up.
Wait, it gets worse. He has had multiple heart attacks and multiple strokes and is a cancer survivor, for real. He is 64-years-old with one foot on a banana peel and the other in the grave.
Let me teach you something about medical underwriting. If it’s one heart attack you write – SINGLE OCCURRENCE – 100% recovery. As if that might help. In insurance lingo anything other than a single occurrence is called CHRONIC!
So, this CUBAN loser who voted for Hillary has CHRONIC heart attacks and strokes. PLUS, there is no way his granddaughters are DAR like mine. SURE, he has $100 million to buy the Florida Governorship but I don’t think that’s enough.
Go ahead and vote for this loser and he will die in the Governor’s Mansion after he spends $41 billion of Federal tax dollars with Florida Medicaid expansion.
All of America should give to Adam Putnam, a real Republican. Make An Urgent Donation To Adam Putnam For Governor!
Adam Putnam needs your support to put Florida First! Our campaign is funded by supporters like you all across this great state. With your help, Adam will work to ensure that our children and grandchildren live in a Florida that’s stronger than the one we already know and love.
https://secure.adamputnam.com/donate_main
I recall a similar discussion (I believe it was with Bob and Barry) a while back. The idea posited that maybe insurers are trying to create perceived value by conspiring with providers to negotiate fake discounts against astronomical list prices. It’s a grand bargain where insurers pay providers more than they otherwise would have received. The health plan gets credit for negotiating prices that are substantially lower than list prices. That scares people into enrolling in coverage to avoid the risk of a catastrophic health problem at list prices. The payer get a bigger cut of the spread between list and negotiated price.
I think the largest insurers these days will tell you that price negotiations are up (or sometimes down) from Medicare rates rather than down from charge master prices. At the same time, very high hospital list prices still have some relevance as part of the formula that Medicare uses to calculate outlier payments for the most complex cases. I don’t think most people could afford to pay for a catastrophic event even at Medicare rates so it’s appropriate and reassuring to have insurance at least to protect against the big, expensive stuff.
It may be a mistake to think it’s all one thing. There’s probably a difference between a hospital whose list price is triple the insurance price, and a diagnostics lab that bills thirteen times the negotiated rate in a Quest to pad its balance sheet, possibly to facilitate ongoing corporate acquisitions.
At the opposite end of the spectrum, my GP and dentist both seem to bill only slightly higher than the insurance rate.
Dr. John Goodman Propaganda in FORBES: Goodman thinks he has all of the answers for the politicians in the Senate. Remember, Goodman has NEVER enrolled one single person into Individual Medical (IM) insurance or a tax-free HSA. But, he thinks he has the health insurance problem all worked out if Employer-Group Plans just pay a fee to Individual Insurance Companies when dying cancer patients are switched to them, too pathetic. He calls this his Health Status Insurance which is only a dream in Goodman’s head. There is no such thing. Also, Goodman insists that the IRS start taxing tax-free HSAs, America’s BEST tax dodge. What a jerk.
None of this will work because the Free and Open Market already has HSA Life Insurance. Goodman is too uninformed to understand what this means. Basically, a 30-year-old woman can get $190,000 with a Critical Illness like heart attack, cancer or stroke for just $30 a month. That is how cheap real insurance is when bean counters and regulators like Dr. John Goodman and Dr. John Graham have not corrupted the market with government regulations.
Blue Cross of Iowa CEO told the Des Moines Register that GUARANTEED ISSUE in Obamacare MUST be maintained and the fines for not having insurance should be larger. The last thing Blue Cross wants is for family members of employees on their employer groups the FREEDOM to buy low-cost medically underwritten insurance. Blue Cross knows that nobody is going to pay $1,000 a month at their job to add the family onto the employers’ insurance if they can get Individual Medical (IM) for $250 a month.
Of course with TrumpCare the Federal government will pay the $250 for IM, PLUS make an HSA deposit into the family’s tax-free HSA. See why Blue Cross is sweating bullets?
people should know when they are conquered
Strength ‘n’ honor – maximus
https://www.youtube.com/watch?v=NYw_8eOwJXk
New York Governor says Medicaid contracts make people billionaires. These Medicaid Billionaire Bozos: Cuomo knows government contracts make the Medicaid Mafia a mint from the ACA’s Medicaid expansion, not to mention other government programs that they helped administer — such as Medicaid Managed Care and Medicare Advantage.
Gov. Cuomo demands, you either lose money in the Individual Market with the Obamacare Exchange in NY or NO government contracts for Medicaid or the really profitable, Children Health Insurance Plan (CHIP-or-KidPloy) for YOU. Keep those expensive 10 essential benefits too.
HOLD THE PHONE: New York’s public programs are heavily dependent on federal funding that lies in Republican crosshairs in both the House and Senate. If Congress follows through on a House proposal to cut more than $800 billion out of Medicaid over 10 years, New York could face an annual bill of $2.3 billion. Its Essential Plan, which has 635,000 enrollees, consumes an estimated $3 billion in annual subsidies covered, for now, by the federal government.
The House GOP repeal measure also would prohibit federal ACA subsidies from being applied to insurance plans that cover abortion. That could be an issue for New York and California, which both require all health plans to provide that coverage.
I say cap those mental health benefits at $100,000 per year. Obamacare’s unlimited lifetime maximum for mental health professionals can be a bit pricey. Government Clinic: We have tons of mental health professionals but we don’t have one surgeon. Usually, when consumers can’t get an appointment with a surgeon we schedule them to see a mental health professional. Is Tuesday or Thursday, the 2nd week in July, best for you? Tell’em how depressed you are. There is probably a medication for that.
http://www.latimes.com/business/hiltzik/la-fi-hiltzik-hardball-20170605-story.html
I think capping mental health benefits is a reasonable idea. It’s hard to measure progress with mental health whereas that’s not the case with high blood pressure, high cholesterol, HbA1c for diabetics, numerous problems that can be resolved with surgery and cancer treatment.
New York is not the only state that is deeply dependent on federal Medicaid dollars…..see the attached from Jeff Goldmsith, an excellent health care commentator:
http://healthaffairs.org/blog/2017/05/30/californias-coverage-expansion-fiscal-and-political-risks/
It is not a secret that Trump (and for that matter, Romney) won a majority of counties in their election bids. It is also no secret that there is a big cultural divide between the Republicans in general vs the big coastal states.
If the Republicans had a bigger majority, (and, some would argue, a better-disciplined majority), they could cut Medicaid and also remove the deductibility of state income taxes. This would be a real broadside, for good or ill.
I have long supported getting rid of the tax deduction for state and local taxes even though I benefit from it. The current tax deduction encourages state and local spending as well as a greater willingness to accede to union wage and benefit demands as compared to what would likely be the case if these taxes weren’t deductible. Elimination of the deduction would free up $1.5 trillion over ten years to support lower marginal income tax rates which would help to spur economic growth.
I also support eliminating the tax preference that has been given to employer provided health insurance since World War II, getting rid of the mortgage interest deduction, and limiting the charitable deduction to the extent that it exceeds 2% of adjusted gross income. None of these are likely to actually become law of course. That’s too bad.
I’ll support getting rid of the deduction for state and local taxes as soon as the mortgage interest deduction goes away.
Bart, why do you link the two together? I think all of these deductions including deductions for healthcare should disappear, but I am confused by your linkage. Wouldn’t it be better to get the good instead of strive for the perfect that you might not obtain?
Devon, what is going on with the blog. As you can see from the earlier threads I had difficulty posting for no reason.
For one thing, I happen to benefit from the state tax deduction. I don’t mind giving up my tax break, but not when I’m paying taxes to finance someone else’s McMansion.
I understand that and sympathize with your feelings Bart, but why would you give up a strong positive advance of our taxation laws because of a relatively unassociated tax break (which is one of many tax breaks)? Additionally, I believe that maximum mortgage debt for interest deductions is $1,000,000. A lot of the deductions for home ownership (i’m not sure about the interest deduction) end up disappearing with the AMT.
Ending the state tax deduction is not an unequivocal improvement. Viewed one way it’s merely protection from having to pay tax on income you never receive because it was deducted by the state. And it’s not inconceivable that high-tax states are spending money on things that would otherwise fall to the feds.
On the other hand there is no valid justification for the mortgage interest deduction, nor for the other special benefits that go along with, it such as the exclusion of capital gains. And I could argue that these are causing considerable harm beyond the reduction in tax base.
Are you saying that a state that spends a lot and therefore has large state taxes should be rewarded by the other states that tax less? That provides the state the incentive to spend and tax more.
“it’s not inconceivable that high-tax states are spending money on things that would otherwise fall to the feds”
Can you provide some examples?
I’m not in favor of the mortgage interest deduction either, but I wouldn’t hold a law ending the tax deductibility of state taxes up because I couldn’t get rid of the mortgage interest deduction in the same bill.
I didn’t say you had to. I merely said I wouldn’t support it.
Tax reform that addresses only relatively benign lower-dollar items like this one or charitable deductions, while ignoring the largest and most destructive, is not really tax reform in my view.
Scroll down to the graph. Low-tax Florida receives $4.50 in Federal spending for every dollar it spends in federal taxes. High-tax states like California and New York are net payers.
https://www.theatlantic.com/business/archive/2014/05/which-states-are-givers-and-which-are-takers/361668/
Bart, your response is not pertinent to the question. We know the federal government gets more money from the people in some states than from the others because of income taxes. That is a given, but you are saying something different.
What are these high tax states spending money on that would otherwise be spent by the federal government if they lowered their taxes on their citizens? That spending under discussion would be in their own state. Can you provide some examples?
“Florida receives $4.50” and your prior point.
Bart, it seems we disagree, but that is fine.
The federal government obtains its revenues from individual taxes, corporate taxes etc. Wealth is not distributed evenly over the country, but the federal government’s major responsibilities is to represent all citizens equally.
It was initially intended that the states manage the states problems. The federal budget was spent mostly on running the initially small government and providing protection from invasion plus a few other things that benefitted almost all in a similar manner. We chose a progressive method of raising revenue that within bounds wouldn’t alter the economic incentives to a great degree. All citizens are taxed under the same laws so one might expect more money to arise from state with a greater population and with higher individual income. Thus unless the government is charging state governments directly I don’t see your point.
Barry,
Every time I start to think you are completely Elizabeth Warren or Maxine Waters kind of Crazy.
You go and post something that totally redeems yourself.
Lee, Blue Cross of Iowa CEO told the Des Moines Register that we must keep Obamacare’s GUARANTEED ISSUE to keep Individual Medical (IM) cost high.
He knows consumers are not going to pay $1,000 a month to add their families on at their job if they can purchase it for $250 a month in the free and open market.
He also says we have to let 26-year-olds add on to their parents’ government plans paid for by the taxpayer. He loves Obamacare.
Barry, What a good idea. In Iowa the State Income tax is really high on those pig farmers. Plus, every school district also has an Income Tax, I kid you not. The State is dying and has no insurance company in the Individual Market and the Governor woman doesn’t list anything about insurance on her goals for the future. She lists more funding for K-12 education, it’s weird. I called her office and a kid named Nick Pottebaum is in charge of the State’s health care policy. Nick graduated from Iowa City in 2012 and worked a couple of years for the election of Gov Brandstad. So, basically, he is a political kid.
There is so much insurance waste in Iowa that they could do away with the State’s Income Tax with TrumpCare.
I asked Lee what do you call multiple DUIs? Lee said, “Habitual”. I said, “Oh!, I call that Chronic.” Regardless, this Governor woman, 1st woman Governor in the State’s history, has multiple DUIs.
Anyway, If I can ever get through to this kid named Nick I am going to ask him why Iowa Taxpayers are paying $1,200 a month for a State Employee to add on a child to their health insurance. This is highway robbery. No person in their right mind would pay $1,200 a month for a child in 2017. Maybe in 2057, but not now. I’m sure that this Nick, in charge of Iowa’s health policy, will have a good answer.
There She Blows!! “Anthem’s exit from Ohio could be the tip of the iceberg,” Cox told Business Insider in an email.
“Their reasons for leaving don’t appear to be specific to Ohio, rather about political and regulatory uncertainty coming from the White House and Congress. If Anthem leaves the market nationally, there could be hundreds of thousands of people without any exchange insurer.”
Tip of the Obamacare iceberg!
If you like your plan you can keep your plan, PERIOD!”-Obama
The Pain in Maine: Rates are in most rate increases are below 50%
Harvard Pilgrim
Harvard Pilgrim seeks the largest rate hike by far, with plans to raise monthly premiums by 39.7 percent. That’s easily the biggest yearly increase any Obamacare insurer has pursued in Maine, though premium hikes are nothing new. If the state insurance bureau approves it, the average Harvard Pilgrim customer would see their monthly premium jump from $468.65 a month to $654.78.
That’s an average increase of nearly 40 percent, so some customers would get hit harder than others. The rate jumps would range from 22.3 percent, which is hardly pocket change, to a much steeper 122.8 percent.
About 21,000 Harvard Pilgrim customers would be affected by the rate increase, if they renew their health plans with the company.
Anthem Health Plans of Maine
Anthem proposed raising monthly premiums by 21.2 percent on average. While some customers would see their rates dip slightly, others would get hit with a price hike of up to 35 percent, according to Anthem’s filing.
Ron
Goodman gets it right when discussing the Health Matching Account
Google Forbes a new approach to high deductibles