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Health Law Saves Consumers by Requiring Insurers to Spend Premium Dollars on Medical Care

11:38 am in Uncategorized by ThirdandState

By Chris Lilienthal, Third and State

Click for a larger viewA key reform in the Affordable Care Act requires health insurers to spend 80% to 85% of premium dollars directly on medical care or quality improvement expenses as opposed to other administrative costs, marketing, or profits. If an insurer does not meet the standard, it must provide rebates to consumers or businesses.

Insurers issued $1.1 billion in rebates to nearly 13 million consumers for 2011, the first year the rule was in effect, and are expected to return more than $500 million in rebates to 8.5 million consumers for 2012. The 2012 figures include nearly $6.9 million that will be returned to 123,581 Pennsylvania consumers — an average of $77 per family.

These rebates are among the more tangible ways that consumers have benefited from the law so far, but it is important to remember, as researchers with the Kaiser Family Foundation recently noted, that rebates represent only a portion of the savings to consumers from this provision, known formally as the “Medical Loss Ratio” Rule (MLR):

The primary role of an MLR threshold is to encourage insurers to spend a certain percentage of premium dollars on health care and quality improvement expenses (80 percent in the individual and small group market and 85 percent in the large group market). The MLR rebate requirement operates as a backstop if insurers do not set premiums at a level where they would be paying out the minimally acceptable share of premiums back as benefits…

Consumers and businesses, therefore, can realize savings in two ways as a result of the MLR requirement: by paying lower premiums than they would have been charged otherwise (as a result of lower administrative costs and profits), or by receiving rebates after the fact.

Final Pa. Budget Fails to Make Up Lost Ground

12:03 pm in Uncategorized by ThirdandState

By Sharon Ward, Third and State

The Pennsylvania Budget and Policy Center has released a full detailed analysis of the 2013-14 state budget plan spending $28.376 billion, roughly $645 million (or 2.3%) more than in the 2012-13 fiscal year.

Governor Tom Corbett signed the budget into law late in the evening of June 30, 2013. Overall, the plan is $64 million less than the Governor proposed in February, reflecting nearly $113 million in reduced spending for public school pensions and school employees’ Social Security payments along with a shift of $90 million in General Fund spending off budget to other funds.

2012-13 General Fund Summary
(in $ Millions)
2012-13 2013-14
Gov.
2013-14
Final
Change f/ 2012-13 %
Change
General Fund $27,731 $28,440 $28,376 +$645 2.3%

The plan includes a small increase to basic education funding, $122.5 million overall, with $30.2 million allocated to 21 school districts through a supplemental allocation, on top of the $90 million increase in the Governor’s proposal.

After many years of cuts, most programs received small increases in the Governor’s proposed budget, which remained in the final plan.

Changes to pension benefits for current employees, the cornerstone of the Governor’s original budget proposal, did not occur. The Legislature does not seem inclined to tamper with benefits for current employees. A proposal to move to a 401(k)-style retirement plan for new employees gained traction later in the session but was not adopted. This proposal may return in the fall.

Also abandoned was an $800 million education initiative to be funded through the sale of state liquor stores. While the privatization vs. modernization debate held center stage until the last week of the session, the school funding component was quickly abandoned and was not part of legislative proposals. Privatization is likely to be considered in the fall, as well.

For the first time in two years, there were no major cuts to services for vulnerable Pennsylvanians; however, a bill that would expand Medicaid coverage in 2014, a state option under the federal Affordable Care Act, was left undone. Legislation including the Medicaid expansion won bipartisan support in the Senate, but the House stripped out the expansion provision from the bill. When the bill returned to the Senate, a last ditch effort to restore the Medicaid expansion provision failed in a dramatic Senate committee vote on July 3.

Finally, a transportation funding package that would repair crumbling infrastructure and give a much needed shot in the arm to Pennsylvania’s flagging job growth failed to pass the House, despite overwhelming support in the Senate.

Get all the details from PBPC’s budget analysis.

Republican Governors Opt-In to Medicaid Expansion

11:28 am in Uncategorized by ThirdandState

By Sharon Ward, Third and State

There is growing bipartisan agreement that the optional expansion of Medicaid provided by the Affordable Care Act is too good an opportunity to pass up.

This month, the Governors of Arizona and North Dakota, both Republicans, announced their intention to opt-in to the Medicaid expansion, joining their counterparts in Nevada and New Mexico. To date, 14 states have decided to expand Medicaid in 2014, and another seven are leaning toward expansion. Pennsylvania remains among the 21 undecided states.

Support for Medicaid Expansion Growing
Here’s what Arizona Governor Jan Brewer had to say about Medicaid:

By agreeing to expand our Medicaid program just slightly beyond what Arizona voters have twice mandated, we will:

• Protect rural and safety-net hospitals from being pushed to the brink by their
growing costs in caring for the uninsured;
• Take advantage of the enormous economic benefits — inject $2 billion into our
economy — save and create thousands of jobs; and,
• Provide health care to hundreds of thousands of low-income Arizonans.

Saying ‘no’ to this plan would not save these federal dollars from being spent or direct them to deficit reduction. No, Arizona’s tax dollars would simply be passed to another state — generating jobs and providing health care for citizens in California, Colorado, Nevada, New Mexico or any other expansion state … With this move, we will secure a federal revenue stream to cover the costs of the uninsured who already show up in our doctor’s offices and emergency rooms … Weigh the evidence and do the math. With the realities facing us, taking advantage of this federal assistance is the strategic way to reduce Medicaid pressure on the State budget. We can prevent health care expenses from eroding core services such as education and public safety, and improve Arizona’s ability to compete in the years ahead. I’m committed to doing this, and I want you on my side. Let’s work together in an atmosphere of respect and do what is BEST for Arizona.

For Pennsylvania, the expansion of Medicaid is projected to bring in $17 billion in new federal investments by 2019, while expanding coverage to between 482,000 and 683,000 uninsured adults.

When Governor Corbett gives his budget address on February 5, he will offer a glimpse into the state’s plans to take advantage of this opportunity. Opting-in will create jobs, strengthen our health care system and provide health coverage to working parents, veterans, and seniors.

Governor Corbett and the Pennsylvania General Assembly should consider the benefits and savings that come with a Pennsylvania Medicaid expansion as well as the price of forgoing this opportunity — fewer jobs, a weakened health care delivery system and hardworking people without affordable insurance.

Mind the gap: Opting Out of Medicaid Expansion Leaves Low-income Families Behind

8:01 am in Uncategorized by ThirdandState

By Michael Wood, Third and State

Federal health care reform is moving forward thanks to the U.S. Supreme Court’s ruling last year — and it is a great deal for Pennsylvania. Unless the state decides to “opt out,” Medicaid coverage will be expanded to include many Pennsylvanians who are uninsured.

One group that will benefit immediately are parents with incomes up to 133% of the federal poverty level ($25,390 for a family of three). The benefits don’t end there: others who don’t receive health coverage through their work will be able to buy insurance on a competitive health marketplace or exchange — making coverage more affordable.

However, if Governor Corbett prevents the Medicaid expansion, it will create a coverage gap for families between 46% and 100% of poverty, as the chart below shows (click on it for a larger view).

Those families between 46% and 100% of poverty earn too much to qualify for Medicaid (for a family of three, this means earning over $8,781 but less than the federal poverty line of $19,090). These families won’t receive Medicaid coverage, and they won’t receive subsidies to buy health coverage.

We all benefit when more people have health coverage. Let’s make the right decision in Pennsylvania and expand Medicaid coverage.

Will Pennsylvania Take Full Advantage of Health Reform?

12:03 pm in Uncategorized by ThirdandState

By Chris Lilienthal, Third and State

With the election decided, it is now clear that the Affordable Care Act is here to stay. That’s great news for Pennsylvanians, some of whom have already begun to benefit from the health reform law, and many others who will see more gains as major provisions take effect in 2014.

As Judy Solomon writes at the Off the Charts Blog, a key provision of the law will allow states to expand Medicaid to cover low-income adults earning up to 133% of the poverty line, with the federal government covering most of the costs:

The question now is whether some states will squander this opportunity to cover millions of uninsured Americans.

Coverage for more than 11 million poor, uninsured adults is at risk if states don’t expand Medicaid, according to the Urban Institute.

Status of Health Reform Medicaid Expansion

As you can see in the chart above, Pennsylvania is among the states that have not made a clear decision on the Medicaid expansion. 

Failing to expand Medicaid would squander the opportunity to boost our state economy. The Kaiser Commission on Medicaid and the Uninsured estimates that the Medicaid expansion in Pennsylvania will amount to at least $17 billion in additional federal dollars invested in the state between 2014 and 2019. By contrast, as Solomon writes, the “Congressional Budget Office estimates that if all states adopt the expansion, they will spend only 2.8 percent more on Medicaid from 2014 to 2022 than they would have spent without health reform.”

Failing to expand Medicaid would also cost Pennsylvania real money that would otherwise be saved by reducing what the state spends to provide health care in emergency rooms and health clinics to people without insurance. 

Governor Corbett and the Legislature should take steps to expand Medicaid in 2014. It will help thousands of working parents and other adults in Pennsylvania get the quality health care they need and give the state’s economy a real boost.

Uncompensated Care Costs Rise at PA Hospitals

12:39 pm in Uncategorized by ThirdandState

By Chris Lilienthal, Third and State

More than a year ago, the Corbett administration decided to end the state’s adultBasic program, which provided affordable health insurance to about 40,000 low-income Pennsylvanians who were unable to obtain coverage from an employer or through other programs.

We worried at the time that many of those newly uninsured would delay treatments until a health condition snowballed into a more serious and costly problem, sending more people to the emergency rooms of our community hospitals.

The Pennsylvania Health Care Cost Containment Council released a report this week showing that uncompensated care costs at hospitals did in fact rise in the 2010-11 fiscal year, when adultBasic ended. Uncompensated care totaled $990 million — an 11% increase over the prior year.

Dave Wenner at the Harrisburg Patriot-News has more:

[Hospitals'] average operating margin was 5.58 percent, up from 4.37 percent the previous year. That means the average hospital had a profit of $5.58 for every $100 in revenue…

“We see the number of hospitals that lost money dropping,” said Joe Martin, the executive director of the cost containment council. “We see the margins rising to a healthy level. That’s all good news.

“The news that’s a little concerning is the spike in the uncompensated care. And there are still a lot of hospitals, particularly the small- to medium-sized hospitals, that are struggling financially. So there is really two sides to the story.”

But the Hospital & Healthsystem Association of Pennsylvania painted a much darker picture, saying the recent numbers “mask” a bleak long-term reality of hospitals struggling against state and federal budget cuts, while straining to provide a safety net for uninsured and under-insured patients.

Local hospitals told the Patriot that the loss of jobs and health insurance in the tough economy, as well as high deductibles and other tactics to shift more health care costs onto patients, played a role in rising uncompensated care costs.

And so did adultBasic’s end, as Sharon Ward of the Pennsylvania Budget and Policy Center noted in the story:

The loss of coverage, Ward said, forces people to wait until they are sick, when they need a maximum level of care and obtain it in the most expensive setting. Then their costs get shifted to people with insurance and government programs, said Ward, who is an advocate for government programs to provide insurance for people who can’t afford coverage.

Let the Games Begin: PA Senate Announces Details of Budget Proposal

9:36 am in Uncategorized by ThirdandState

By Sharon Ward, Third and State

Action on the state budget began in earnest Monday with state Senator Jake Corman, chairman of the Appropriations Committee, releasing important details on the Senate budget plan that will be advanced this week.

The proposal would increase Governor Tom Corbett’s budget proposal by $500 million, with total spending rising from $27.15 billion to $27.65 billion for 2012-13. The Senate plan rejects $191 million in fund transfers and new revenue and proposes new spending cuts of $165 million. Those spending reductions were not yet detailed.

According to a Capitolwire.com report (subscription required), the Senate budget plan:

  • Restores $245 million to higher education;
  • Does not include block grants for county human services or basic education;
  • Reduces the county human services funding cut from 20% to 10%;
  • Restores $50 million to Accountability Block Grants (which fund quality pre-kindergarten and full-day kindergarten);
  • Restores $14 million in cuts to early childhood education;
  • Reduces the transfer from the Keystone Recreation, Park and Conservation Fund (Key ‘93 Fund) from $38 million to $19 million;
  • Cuts PHEAA by $8 million rather than the $19 million proposed by the Governor; and
  • Maintains $59 million for the CURE health research program in the Tobacco Settlement Fund.

Senator Corman, who announced the details, said the Senate wanted to take a step back on the proposed education block grant because “a lot of people are opposed to it” and will wait to get more feedback from school districts. On the human services block grant, Corman said, “we did not get into whether it is block granted or not.”

It’s not clear that a 10% cut in county human services will seem like much of a victory to the folks fighting that battle. And since House leaders had been talking $100 million for Accountability Block Grants, there may be some trading to come. It’s not clear whether we can get a spend number higher than $27.615 billion so there is a lot more work to be done.

Will welfare programs get cut again?

The Senate plan includes $40 million in revenue from “recalculating Social Security and welfare costs.” The Social Security side is what school advocates have identified as double counting on charter school Social Security payment. The $165 million in unspecified spending cuts, plus the welfare savings, could be a cause for concern.

The preliminary revenue estimate released by the Independent Fiscal Office (IFO) last week provided crucial cover to state lawmakers who have been hammered for months in Harrisburg and in the press about the consequences of the Governor’s proposed cuts. The IFO, which was established precisely for the purpose of providing a revenue estimate “independent” from the Governor, projects that Pennsylvania will end the current fiscal year with about a $400 million balance, and raise $400 million more than originally projected in the new fiscal year.

To make the Senate plan more palatable to lawmakers, especially those in the House loathe to spend a dime more even if bridges are falling down around them, Senator Corman argued that the spending plan would meet TABOR targets. That, of course, should send shivers down all of our spines.

TABOR — the Taxpayer Bill of Rights — is the failed experiment in Colorado, which limited state spending to a formula of inflation plus population growth. If tax collections run higher than that, officials are supposed to send the money back to taxpayers as a rebate. In 2005, voters in Colorado passed a referendum suspending this crazy system for five years.

Why would voters turn down a tax rebate check? I guess they tired of the gimmick. The last time I looked, local governments had passed 1,400 tax increases to make up for state funding cuts.

PA Tax Breaks Vs. Budget Cuts

12:37 pm in Uncategorized by ThirdandState

By Chris Lilienthal, Third and State

Right now in Harrisburg, there is a debate going on over whether the state should make more cuts to schools, universities and protections for our children and grandparents. Unfortunately, the Governor has put forth a budget that would do just that.

The chart below from Better Choices for Pennsylvania compares existing tax loopholes with funding cuts that could be restored by closing loopholes. In each case, additional revenue could help fund vital services without raising taxes on the middle class.

Nowhere to Go, More Addicts on the Street and a Ringing Irony

7:31 am in Uncategorized by ThirdandState

Unsettling & Uncertain Future (photo: aphrodite/flickr)

Unsettling & Uncertain Future (photo: aphrodite/flickr)

Based on blog posts by Chris Lilienthal originally published here and here at Third and State.

The Philadelphia Inquirer reports this morning on the impact of Pennsylvania Governor Tom Corbett’s proposed budget cuts on the lives of people in Southeastern Pennsylvania. Who is getting hit? Adults with disabilities, the homeless, people with mental-health illnesses, HIV patients needing hospice care, children aging out of foster care, and seniors, among others.

Miriam Hill, The Philadelphia InquirerPeople who will be affected by Corbett’s cuts:

Brittany Stevens doesn’t talk a lot, but she’s a bit of a social butterfly. She was a prom queen and, after a recent performance of the musical Fela!, she spontaneously hugged the dancers, nearly tackling them in excitement.

But Brittany, 21, who is disabled and suffers from seizures, incontinence, hearing loss, and other problems, spends most of her days alone in her North Philadelphia home, while her mother, Harlena Morton, goes to work as a high-school counselor.

Morton had hoped to find Brittany a job in a workshop that employs disabled adults. Now that Gov. Corbett has proposed large cuts to social services programs, Morton fears that Brittany and thousands like her will never get off waiting lists for those spots and for other services…

In Philadelphia, the cuts total about $120 million, not including reductions in medical care, city officials say; across Pennsylvania, $317 million, according to state officials.

The Governor’s 2012-13 budget proposes to completely eliminate the General Assistance Program, which provides a time-limited, modest $205 per month benefit to people who are sick or disabled, completing addiction recovery programs or children who would otherwise be in foster care. Again, from the Inquirer: Read the rest of this entry →

The Return of Bigfoot: Telling the Truth about Welfare Spending in Pennsylvania

10:08 am in Uncategorized by ThirdandState

(photo: chiceaux, flickr)

(photo: chiceaux, flickr)

A blog post by Sharon Ward, originally published at Third and State.

You may remember that the Commonwealth Foundation put out a report about welfare spending a couple of weeks ago that we likened to “Bigfoot” because it found something in the Department of Public Welfare — massive fraud, millions of non-working adults — that just didn’t exist.

I had a chance to debate Matt Brouillette of the Commonwealth Foundation on WITF’s Radio Smart Talk, and I thought it might be a good time to share the facts and give you my four big ideas about how we push back on the destructive framing that the “Bigfoot” report perpetuates.

First, let me give a shout out to the people who called in to Smart Talk to set the record straight on welfare spending and challenge Matt directly on his use of the welfare frame. It was clear to the listeners that Matt was quite deliberately trying to invoke the image of Ronald Reagan’s welfare queen by describing welfare as everything from afterschool programs to autism services. The audience wasn’t buying it and we shouldn’t allow it.

The first step  when talking about this issue, is to define welfare accurately.

1. Welfare is cash assistance.

Assistance for people with intellectual disabilities, child care assistance for working families, nursing home care, child protective services and community-based supports for people with disabilities are not welfare. Anyone who suggests so should be shouted down — fast and hard.

2. Cash assistance spending isn’t growing.

Cash assistance spending is 2% of the budget in Pennsylvania and averages 2% of state expenditures, according to the National Association of State Business Officials (NASBO). Pennsylvania doesn’t spend more on cash assistance than other states.

Welfare is a time-limited benefit, available for women with children. Enrollment in welfare had dropped by more than 50% after welfare reform in the 1990s, and about 70% of the caseload is children.

During the recession, Pennsylvania’s cash assistance rolls barely grew. One of the untold stories of the past few years is how cash assistance played no role in helping shield families with children from the effects of the recession.

What about the state’s welfare budget?

Matt Brouillette and Department of Public Welfare Secretary Gary Alexander have made much of the fact that department spending is, for the first time in 2011-12, the largest expenditure in the state budget. The fact is that welfare didn’t grow; education shrank. The education budget, which is typically the largest budget item, was hacked by close to a billion dollars. Read the rest of this entry →