Posted tagged ‘medicaid’

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Nonsense from the Far Right

August 24, 2012

Political consultant Dick Morris slipped into Iowa last week, and the Spin-O-Meter was in overdrive.

Now, rather than repeat Mr. Morris’ misinformation, here is a link to a Des Moines Register story about his appearance at a rally orchestrated by the national right-wing organization Americans for Prosperity.

What Iowans need to know is that (1) Morris is wrong about what is driving the federal budget deficits, and (2) the causes are clear: You can’t cut taxes and fight two wars at the same time without digging a big budget hole.

Center on Budget and Policy Priorities graph

Center on Budget and Policy Priorities

As shown in the graph at right from the Center on Budget and Policy Priorities, the economic downturn, President Bush’s tax cuts and the wars in Afghanistan and Iraq explain the vast majority of the deficit through 2019. One thing folks must recognize is that deficits caused by those factors cause more debt down the road, because we have to keep paying interest. Even after the Iraq war ended, we have to keep paying for it.

As we deal with these self-inflicted budget problems, we must maintain the fundamental and long-accepted responsibilities of our nation — to care for the most vulnerable and put them on their feet to get work and succeed in our economy.

Dick Morris has a big megaphone to try to instill something other than a factual presentation about what’s causing our deficits and debt. Fortunately, the discerning Iowan can find the facts by looking for them, and not buying into the conventional spin he delivers in his traveling medicine show.

Posted by Mike Owen, Assistant Director

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Why the federal budget debate matters in the states

August 9, 2012

There’s doggone near nobody who isn’t concerned about dealing with the nation’s long-term budget challenges of deficit and debt.

What not enough people will recognize, however, is the danger of diving headlong into a deficit-cutting approach that just digs a deeper hole, both for the economy and for the critical services that federal, state and local government spending supports.

Ryan budget impacts

Center on Budget and Policy Priorities

And that’s the problem with the so-called “Ryan Budget,” named for Congressman Paul Ryan. That approach, passed by the House, makes cuts to funding for state and local services that are far deeper than the cuts many expect to happen with sequestration, the automatic cut process demanded by last year’s Budget Control Act compromise.

A new report from the Center on Budget and Policy Priorities outlines the challenge for states generally with the Ryan approach:

  • Federal cuts of 34 percent by 2022 to Medicaid compared to current law, and by steadily larger amounts after that.
  • Federal cuts of 22 percent in 2014 and in later years to non-defense “discretionary” spending — which leaves Medicare and Social Security alone but hits local and state services in education, infrastructure such as roads and bridges, and public health and safety including law enforcement.

For Iowa, the non-defense “discretionary” cuts are projected at $237 million in 2014 alone, and $2.1 billion from 2013 through 2021.

Want clean water? If you live in Iowa, where the state routinely shortchanges environmental enforcement, how bad do you think things might get when the federal funds are cut as well? Concerned about the quality of your food? Or your kids’ schools? Maybe the safety of the bridge you’re approaching on the way to work?

Well, folks, you get what you pay for.

Posted by Mike Owen, Assistant Director

Categories: Budget and Tax, Economic Opportunity, Energy & Environment, Organization
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Iowa leads the way to kids’ health coverage

January 23, 2012
Andrew Cannon

Andrew Cannon

Two recent reports highlight Iowa’s success in extending health insurance coverage to children. Both reports are the work of the Kaiser Family Foundation (KFF), a nonprofit private operating foundation, based in Menlo Park, Calif., dedicated to producing and communicating the best possible information, research and analysis on health issues.

The first report — “Performance Under Pressure: Annual Findings of a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost-Sharing Policies in Medicaid and CHIP, 2011-2012” — demonstrates the steps that all states are taking to cover children. For instance, hawk-i, Iowa’s version of the Children’s Health Insurance Program (CHIP), has expansive income eligibility guidelines, allowing children from families with income up to 300 percent of the federal poverty level ($67,050 for a family of four) to enroll in the program. Only two states (New York and New Jersey) have broader eligibility guidelines.

Iowa has enacted other policies that make enrolling in public programs less cumbersome, less costly, and more consistent with the goal of getting kids covered.

KFF’s second report highlights Iowa — along with Alabama, Massachusetts and Oregon — among states leading the way in children’s health coverage. “Secrets to Success: An Analysis of Four States at the Forefront of the Nation’s Gains in Children’s Health Coverage” notes that Iowa has experienced, thanks to its use of CHIP in policies including hawk-i, a nearly 20 percent decrease in the number of uninsured kids. Efforts to expand and simplify the eligibility and enrollment process are key to Iowa’s success in covering kids.

As we noted last month, Iowa’s efforts to cover kid not only help the kids and their families, but also help the state. The U.S. Department of Health and Human Services awarded Iowa with a $9.5 million Children’s Health Insurance Program Reauthorization Act bonus payment in late December, in reward for the state’s efforts to expand children’s health insurance coverage.

Though Iowa has implemented some of the policies that led to success in kids’ coverage in the adult health coverage program, Medicaid, additional policy changes could further reduce the overall rate of uninsurance in the state. For instance, Iowa’s Medicaid eligibility thresholds are Iowa are quite low, especially in comparison to hawk-i eligibility levels. 

Both Kaiser reports note that Iowa, like every state, will face challenges to maintain and further improve its health insurance coverage. Budgetary pressures, burgeoning caseloads and a growing strain on information technology systems make it difficult. However, both articles illustrate a number of policies Iowa could pursue to continue to be a leader in kids’ health coverage.

Posted by Andrew Cannon, Research Associate

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Expanding kids’ coverage pays dividends

December 29, 2011

Andrew Cannon photo

Andrew Cannon

Iowa has made a huge effort in recent years to expand health insurance coverage to children. Those efforts are paying dividends to the newly covered children and their families, of course, but also to the state.

The 2009 Children’s Health Insurance Program Reauthorization Act (CHIPRA) gave states new tools to make insuring kids easier. Many of these tools meant a reduced workload for state enrollment officials, and made it easier for families to obtain coverage for their children. CHIPRA also provided cash bonuses to states that implemented the tools and excelled in enrolling children in public health insurance programs.

On Wednesday, the U.S. Department of Health and Human Services announced that Iowa is one of 23 states receiving a CHIPRA bonus for performance in 2011. Iowa is one of just five states to have implemented nearly all of the CHIPRA enrollment tools. Iowa’s $9.5 million bonus can be used to further improve enrollment and eligibility processes or to offset the cost of increased enrollment.

In addition to streamlining the  Medicaid and hawk-i (Healthy and Well Kids in Iowa — the state’s CHIP program) enrollment process, Iowa has also increased enrollment beyond a baseline level, further increasing the size of the bonus. In November 2011, more than 34,000 children were enrolled in hawk-i, with 248,000 enrolled in Medicaid, compared to 22,300 and 219,000, respectively, in July 2009, just months after CHIPRA passed.

Undoubtedly, the effect of thousands of Iowa parents losing their jobs and health insurance has contributed to enrollment increases. Nonetheless, the tools CHIPRA made available, as well as Iowa’s implementation of many of them, made the process of enrolling kids in public health insurance programs less onerous for many parents at a time they most needed assistance.

Posted by Andrew Cannon, Research Associate

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Wellmark’s ‘uncertainty’ should not affect Iowa’s exchange

September 2, 2011
Andrew Cannon photo

Andrew Cannon

Any business worth its salt can find a way to make a buck in a market with sufficient consumer demand.

Wellmark’s reported uncertainty in its ability to “break even” in the health reform-created insurance marketplace would seem puzzling for a company with 70 percent of the Iowa market.

According to an Aug. 31 Des Moines Register report (“Wellmark undecided on insurance exchange,” by Tony Leys), Iowa’s largest insurer is unsure it will participate in the health insurance marketplace created by the health reform law, citing concerns about its ability to “break even.”

This marketplace could be the place where as many as 156,000 Iowans* seek to purchase health insurance. Those with household income below 400 percent of the federal poverty line (about $89,000 for a family of four) will receive tax credits from the federal government to help cover the premium cost. And small businesses, which will also be eligible to purchase insurance in the exchange, will receive tax credits if they cover at least half of their employees’ premiums.

The stars are aligned to create consumer demand in the new insurance marketplace. Wellmark’s concern about breaking even probably should not be lawmakers’ first concern. The point of the exchange is to enhance the marketplace, not keep it restricted.

Rather, as we have repeatedly stressed, policy makers need to be focused on how to assure that lawmakers create an Iowa exchange that is fair and consumer-oriented.

Two groups heretofore are woefully underserved by the current health insurance market — individuals and families who don’t receive health insurance benefits at work, and Iowa’s small businesses. The exchange’s structure and governance should assure that Iowa individuals, families and small businesses can find affordable health insurance options.

In a strong, consumer-oriented exchange, small businesses, individuals and families will want to participate. Why would Wellmark not want a share of that playing field?

*Note: Data comes from the 2009 American Communities Survey (ACS), analyzed online using the University of Minnesota’s Integrated Public Use Microdata Series (IPUMS-USA). The ACS is conducted on an ongoing basis by the Census Bureau. Those 156,000 Iowans have household income in excess of 133 percent of the federal poverty level – the cut off point for Medicaid eligibility under health reform.

Posted by Andrew Cannon, Research Associate
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Medicaid cuts would hurt Iowa

May 10, 2011
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Andrew Cannon

The recently passed House budget plan, authored by Representative Paul Ryan, would radically alter Medicaid as we know it. These changes would push hundreds of thousands of Iowans off the Medicaid rolls and into the ranks of the uninsured, and would reduce federal payments to the state by billions.

Under the proposal, states would receive a set amount of federal money, known as a block grant, for Medicaid, rather than the matched federal funding in the present form of Medicaid. The proposal would also repeal the Affordable Care Act, affecting a projected 16 million Americans who would be covered through the new health law’s expansion of Medicaid.

The Kaiser Commission on Medicaid and the Uninsured estimates that the the House Budget Plan’s repeal of the Affordable Care Act alone would result in 56,000 Iowans losing Medicaid coverage. Over 10 years, Iowa would lose $6.6 billion in Medicaid funds.

And the state wouldn’t be the only entity to take a financial hit: Iowa hospitals would lose out on over $300 million in Medicaid payments in 2021 because of the House budget.

Converting Medicaid to a block grant program would require states to drastically reduce their Medicaid programs.

Putting the results of the proposal in human terms is a bit stickier, as state Medicaid programs are required to serve certain populations by federal law and may, at a state’s discretion, cover other populations. Further, these groups cost wildly different amounts of money to cover. For instance, children make up well over half of Iowa’s Medicaid enrollees, yet account for just 16 percent of all Medicaid spending in Iowa. By contrast, only about 20 percent of Iowa’s Medicaid enrollees are persons with disabilities, yet Iowa spends nearly half of its Medicaid funds on persons with disabilities.

Under Kaiser estimates, various approaches could cut from 153,000 to 273,000 Iowans from Medicaid.

In one model, Kaiser assumed cuts caused by a Medicaid block grant would be spread evenly across all enrollment groups. In this model, the House plan would require cutting as many as 153,000 Iowans from the Medicaid rolls.

If, on the other hand, Iowa lawmakers decided to shield the elderly and persons with disabilities from Medicaid cuts necessitated by the House plan, children and adults would bear most effects: 273,000 Iowa children and adults under age 65 would be cut from the Medicaid roles.

Reducing federal deficits over the long term is a worthy goal. But it should as part of a balanced approach that includes revenue improvements, and not at the expense of our most vulnerable citizens.

Posted by Andrew Cannon, Research Associate

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Health reform turns 1

March 25, 2011
Andrew Cannon photo

Andrew Cannon

A year after it was signed into law, confusion about the health reform law remains high. With the heated rhetoric and widespread misinformation about the law, citizens can hardly be blamed for not yet understanding the Affordable Care Act.

Over the course of this week, the Iowa Fiscal Partnership — a joint project of the Iowa Policy Project and the Child and Family Policy Center — has tried to combat some of that confusion and outright misinformation. In a series of five “issue snapshots,” we have succinctly explained how certain groups of Iowans will be impacted by the health law.

On Monday, our brief snapshot described some features of the law designed to help small businesses, which provide insurance to employees in far lower numbers than larger firms. Small businesses may qualify for tax credits if the provide coverage to employees now, and will have access to a new health insurance marketplace beginning in 2014.

Our Tuesday release focused on how senior citizens will be impacted by the new law. Gaps in Medicare prescription drug coverage will gradually be phased out and Medicare enrollees need no longer worry about co-pays for approved preventive treatments.

On the actual anniversary of health reform becoming the law of the land, our Wednesday snapshot explored some of the consumer protections featured in the law. Patients’ need no longer worry about bumping against a benefits ceiling; lifetime benefit limits are eliminated and annual benefits limits will be phased out. The law enshrines the right of patients to choose their own provider; that choice may not be dictated by insurance carriers or the government.

Our Thursday snapshot focused on the law’s impact on Iowa women. Many women are only one family tragedy away from losing their coverage. Just 28 percent of Iowa women have their health coverage through their own job.  In 2014, Iowa women, along with all Iowans, will have a host of new health coverage options. Medicaid eligibility will be raised and lower- and middle-income families will be eligible for premium assistance from the government to purchase insurance coverage in the new state-based marketplaces.

Today, our snapshot details some of the law’s benefits for Iowa’s youth — from infants up to 25-year old young adults. The 51,300 Iowa children with a pre-existing condition will never be denied coverage for that reason; insurers are prohibited from denying children health coverage due to pre-existing conditions. Young adults through age 25 may also remain on their parents’ insurance plans, regardless of whether they are in school or just starting a career.

In spite of some of the heated rhetoric that continues against health reform, it will help thousands of Iowans receive better and more affordable health coverage, as well as protecting their rights as patients.

Posted by Andrew Cannon, Research Associate

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But what have you done for me lately?

February 11, 2011

Source: Suzanne Mettler, "Reconstituting the Submerged State: The Challenges of Social Policy Reform in the Obama Era," via Sara Robinson, Campaign for America's Future

This NYTimes blog post is interesting enough, but what really caught my attention was a table from a recent academic political science paper that has made its way from liberal bloggers to a former Reagan economic advisor.

An astounding number of people have no idea what their government does for them, even as they benefit from government programs.

 

Posted by Andrew Cannon, Research Associate

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Unfunded Mandates? Not Quite, Governor

January 20, 2011
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Andrew Cannon

This week, Governor Branstad signed Iowa on to a multistate lawsuit challenging health care reform. In his statement announcing that Iowa would join the suit, Governor Branstad said the health reform law would “shackle Iowa taxpayers for billions in unfunded mandates.”

You may be wondering what “unfunded mandates” he’s referring to. So am I.

He might be talking about the individual responsibility requirement, since that is the provision that is being challenged in the lawsuit. Section 1501 of the Affordable Care Act requires all individuals to maintain health insurance coverage or face a tax penalty (with exemptions for those with religious oppositions or with financial difficulties).

But the individual mandate is not “unfunded;” indeed, it is largely funded by the federal government. Individuals and families earning up to 400 percent of the federal poverty level  ($88,200 for a family of four) are eligible for premium assistance. The vast majority of Iowa’s uninsured, approaching 300,000 Iowans, will be covered by the Affordable Care Act’s expansion of Medicaid. After the Medicaid expansion, the majority of the remaining Iowans will be eligible for the health insurance premium tax credits. Only about 27,400 Iowans earned more than 400 percent of the FPL ($88,200 for a family of four) and were uninsured, on average, from 2008 to 2010.

On the other hand, Governor Branstad could have been referring to the expansion of Medicaid as an “unfunded mandate.” As noted above, the Affordable Care Act vastly expands the Medicaid program, allowing all individuals with income below 133 percent of FPL ($29,326 for a family of four) to enroll. Medicaid is jointly financed by the states and the federal government, with the feds picking up the lion’s share of the tab. In normal times, the federal government pays for around 63 percent of the Medicaid program in Iowa; in recent years, that has been increased to around 71 percent, thanks to the federal Recovery Act.

But unlike traditional Medicaid, which comprises a large portion of the state’s budget, the Medicaid expansion will be almost entirely funded by the federal government. In other words, no unfunded mandate here, either. During the first three years, (2014-2016) the costs of expansion will be fully covered by the federal government. In subsequent years, the federal government’s share of the expansion costs will decrease, but not by much. In 2020 and beyond, Iowa will only be paying for 10 percent of the cost of the Medicaid expansion.

The fate of the lawsuit (and thus reform) is unclear, at this point, though experts and administration officials alike are confident that health reform will survive the legal challenges. Given the diverse rulings to date, the challenge will likely be resolved by the Supreme Court.

What is clear, however, is that the mandates in the Affordable Care Act are not “unfunded.” Though Iowa will be required to cover a small portion of the costs of the Medicaid expansion, this hardly qualifies as “shackl[ing] Iowa taxpayers.”

Posted by Andrew Cannon, Research Associate

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Robbing the hungry tomorrow to help the sick today?

July 30, 2010
Andrew Cannon, research associate

Andrew Cannon

Should we rob the hungry tomorrow to help the sick today?

Economic recovery efforts should be aiding both — and other vulnerable populations — and neither at the expense of the other.

Congress is showing renewed interest in passing an extension of the temporary increase in the federal government’s share of Medicaid financing.

The proposed extension, however, could come at a steep price. To offset the cost of extending the Medicaid increase, Congress is looking at reducing Supplemental Nutrition Assistance Program, or SNAP (formerly known as food stamps) by $6.7 billion.

Deficit demagogues may be making points in Congress, but they miss the point about good recovery policy.

It’s no secret that the federal budget deficit has grown over the past decade. But the long-term deficit is primarily due to a few select causes: the Bush tax cuts of 2001 and 2003 that heavily favored the highest earners, the deficit-financed wars in Iraq and Afghanistan, and the dip in tax revenues due to the recession.

Recession recovery efforts, such as the Recovery and Reinvestment Act of 2009, which included the original increase in federal Medicaid payments, add a negligible amount to the long-term deficit, while providing immediate benefits to the most vulnerable Americans and stimulating the economy. An analysis of Recovery Act provisions by Mark Zandi, chief economist at Moody’s Economy and former economic adviser to Sen. John McCain’s presidential campaign, estimated that every federal dollar invested in SNAP generates $1.74 of economic activity.

Congress will need to address deficit concerns. But doing so at the expense of the most vulnerable Americans doesn’t make sense fiscally, morally or economically.

Posted by Andrew Cannon, Research Associate

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