Derrick's Progressive News
Contents
Some States Say They're Not Receiving the Medicaid Services They're Paying For
Bernie Buzz: Health Centers Save Billions
MoveOn.org’s Top 10 Corporate Outrages
Wealthy Reap Rewards While Those Who Work Lose
Steve Weiss provided this article/link.
Under the new healthcare law, Medicaid will expand by at least 16 million people as eligibility is raised in 2014 to a new nationwide standard of 133 percent of the poverty level. The surge in enrollment will be highest in states in the South and West, where eligibility standards have been stringent.
SOURCE: Kaiser Family Foundation | The Washington Post - July 8, 2010
Some States Say They're Not Receiving the Medicaid Services They're Paying For
Steve Weiss provided this article/link.
By Alec MacGillis
Thursday, July 8, 2010; A10
MILWAUKEE -- The day after the House passed the landmark health-care bill in March, St. Louis-based insurer Centene saw its stock jump 11 percent. That was perhaps the first signal that the major changes ahead would be a boon to one subset of the health-care industry: companies that manage Medicaid for the states.
Now businesses are rushing to get a foothold in states that outsource Medicaid, knowing the law could add 16 million people to the federal-state program for the poor and the disabled. In Texas, where Medicaid rolls are expected to grow by 1.8 million people, Centene is scrambling to win additional contracts, having laid the groundwork by contributing $250,000 to state legislators' campaigns since 2008.
"We .. . . believe we are extremely well-positioned to benefit in this new era," Centene chief executive Michael Neidorff told market analysts during a recent conference call.
But the experience in some states suggests pitfalls ahead. A recent report found that 2.7 million children on Medicaid in nine states, most of them states that outsource Medicaid, are not receiving required screenings and immunizations.
In Milwaukee, the two biggest provider networks in the city broke ties with Centene, and the state is overhauling its Medicaid contracts for southeast Wisconsin, dropping Centene from the mix. The complaint was that the insurer was creating profits at the expense of patient care, a charge the company denies.
"We came to the conclusion about a year ago that we were unsatisfied with the quality of care we were getting, given the amount of money we were paying," said Jason Helgerson, Wisconsin's Medicaid director.
With an expanded Medicaid absorbing at least half of those newly covered under the health-care law, Medicaid HMOs will play an outsize role in managing costs. Some studies suggest that managed Medicaid has, in certain states, slowed the increase in costs without harming care and has even improved care for some conditions. The theory is that insurers can save states money by reducing avoidable treatments -- by monitoring diabetics to keep them from needing dialysis, for example.
But managed Medicaid has also produced a steady stream of controversies. Last year, insurer WellCare agreed to pay Florida $40 million in restitution after it admitted shortchanging children on Medicaid by setting up a subsidiary to make it look like WellCare was spending more on medical care than it was.
Today, 70 percent of the 48 million Medicaid enrollees are in a managed plan. States typically pay insurers a per-person rate, and the insurers, or HMOs, negotiate rates with doctors and hospitals.
Managed Care
Most economists agree that managed care is more efficient than paying doctors and hospitals separately for each treatment. But it can be hard to find the right balance in Medicaid -- enrollees are less likely to push back when needed treatments are withheld, and states are conflicted in monitoring insurers they hired to keep costs down.
Jane Perkins, legal director of the National Health Law Program, said the potential expansion of Medicaid HMOs under the new law "is not necessarily a bad thing." But, she added, "what gets bad is when they're taking their per-month, per-member payments and using it for profit, not patient care."
Although some states manage the program on their own, the majority -- among them Virginia, Maryland and the District -- contract out most of their Medicaid. And now insurers are vigorously lobbying state legislators for more outsourcing, using states' budget woes as a goad.
In Florida, where 950,000 people are expected to join Medicaid, insurers are pushing for the expansion of a managed-care pilot program despite mixed evidence about its early results. In Texas, they are pushing to expand managed care into the Rio Grande Valley, where there are 350,000 Medicaid enrollees even before the new law takes effect.
New insurers are moving into the market now dominated by giants such as WellPoint and UnitedHealth and companies specializing in Medicaid, such as Centene, Molina and Amerigroup. Centene has swelled to $4 billion in revenue, cracking the Fortune 500 last year, with more than 1 million Medicaid enrollees in nine states. Neidorff, its chief executive, earned $6 million last year.
The company attributes its success to shrewd selection of markets and a sophisticated system for managing care. It holds up as an example the care it provides to high-risk pregnant women, making sure they receive a weekly steroid injection to reduce the rate of premature births.
"Years ago, the formula was to deny care, but that's not what managed care is about now," said Centene spokeswoman Toni Simonetti. "It's about trying to provide healthier outcomes. . . . Better health outcomes are the least-costly outcome."
The company has worked hard to encourage lawmakers to expand Medicaid, spending $1.53 million on lobbying in Washington since 2007. Most of the $1 million raised by its political action committee since 2004 has gone to state-level candidates. Its corporate board includes former House speaker Richard A. Gephardt (Mo.), a Democrat who runs a Washington lobbying firm, and former U.S. health secretary Tommy G. Thompson, a Republican who pioneered Medicaid HMOs as Wisconsin governor and works for the lobbying firm Akin Gump.
For years, Centene had such steady profits in Wisconsin that in 2008, Neidorff compared it to turning on a "milking machine." But that year, Aurora Health Care, the state's biggest provider network, cut its contract with Centene after objecting to its reimbursement rates. Milwaukee's other big provider network, Wheaton Franciscan, also severed ties with Centene.
Simonetti described this as part of the "naturally occurring tensions" with providers. But Aurora President Nick Turkal pointed to a broader issue: Managed care in Wisconsin is falling far short of the ideal, with too little done to get enrollees the primary care they need and keep them out of the emergency room.
"The problem with this concept of managed care in Wisconsin is that it hasn't really been managed," he said.
The state rebid the contract for southeast Wisconsin with stricter standards on diabetes management and other care. It selected four insurers that included UnitedHealth but left out Centene, which is appealing in court.
One Clinic's Situation
Whatever the outcome, the shift toward Medicaid managed care may have helped create at least one casualty, a small clinic on the Near North Side of Milwaukee. The Milwaukee Immediate Care Center prides itself on providing a level of enhanced primary care that clinic administrator Perry Margoles says prevents countless emergency room visits -- offering free blood pressure screenings, taking the time with patients coming in with a single complaint to provide a more comprehensive assessment, with an EKG machine on hand if needed.
But Centene long resisted paying the extra $25 fee the clinic charges for patients not assigned to its doctors. And after the clinic closed in 2007 for flood repairs, Centene declined to renew its contract. The clinic had better relations with UnitedHealth, but the insurer dropped its urgent-care contract in 2007 and has, Margoles said, been late in paying many claims.
Simonetti declined to discuss the situation in detail, saying only that the clinic "did not meet our standards." A UnitedHealth spokesman did not respond to a request for comment.
Business has fallen by half from three dozen patients a day. Margoles has shifted his three doctors to part time and cut weekly hours of operation from 125 to 55. One recent weekday, several people trickled in, including Latonya Fortson, a home health aide who is covered by Centene but still comes to the clinic even though it means paying cash -- in this case, $20 for a tuberculosis test.
"It's right here in the community," she said. "I like the service."
With the clinic in tax arrears, Margoles said he is on the verge of closing. He worries about the "collapsing health infrastructure" in the community. And he worries what expansion of managed Medicaid will mean for other states where regulators are considered less capable than the ones that he has found lacking in Wisconsin.
"The Medicaid HMOs are maximizing their profits at the expense of an underfunded system," he said. "If they're pulling this [stuff] in Wisconsin, can you imagine what's going to happen in other states?"
It's time to return to government of, by and for the people.
And the best way we can do that is to ensure that our elected officials are accountable to "we, the people" -- not "they, the corporate lobbyists" -- by passing the Fair Elections Now Act.
http://www.commoncause.org/site/apps/fc/form.asp?c=dkLNK1MQIwG&b=6125389&auid=6598244
Bernie Buzz: Health Centers Save Billions
A new study projects billions of dollars in savings from a major investment in community health centers. Bernie’s provision in the new national health care law will double the number of centers providing affordable primary care, dental care, mental-health counseling and low-cost prescription drugs. The George Washington University study said the $11 billion investment will save $180 billion over the next 10 years by keeping people out of expensive hospital emergency rooms. To read more, click here.. To watch excerpts from the press conference, click here.
Wall Street Reform
A final Senate vote is likely this month on Wall Street reform legislation. “It is modest. It doesn’t go far enough,” Bernie said of the House-passed package that fails to break up too-big-to-fail banks and does not include a cap on credit card interest rates. The measure does, however, include Bernie’s provision to lift the veil of secrecy that shrouds the Federal Reserve. A Bloomberg News investigation provided fresh evidence why the central bank must be audited. To read how the Fed made taxpayers unwitting junk-bond buyers, click here.
Big Oil
In the wake of the BP oil spill in the Gulf of Mexico, Congress so far has done practically nothing. A bill that cleared the Senate environment committee last week would make BP foot the entire bill for cleaning up the spill and for economic losses. The energy committee, on which Bernie also sits, voted to deny offshore leases to companies with poor track records, but unfortunately did not accept his bill to ban drilling off the Pacific and Atlantic coasts and parts of the Florida gulf coast. And the full Senate nixed his amendment to end $35 billion in oil industry tax breaks and devote the savings to energy efficiency and deficit reduction.
Hypocritical Budget Hawks
Bernie’s bill to stop oil tax breaks would devote $25 billion to deficit reduction - and $10 billion to energy efficiency. An estate tax he proposed on the wealthiest Americans would bring in at least $319 billion over the next decade to help lower the national debt. Many of the same Republican deficit hawks who oppose those proposals voted in the past for massively expensive legislation but somehow neglected to pay for it: two wars in Iraq and Afghanistan, tax breaks for the wealthy, a prescription drug bill written by the pharmaceutical industry, and a $700 billion Wall Street bailout. “I get a little bit tired of being lectured by Republicans for the deficit,” Bernie said in a Senate floor speech.
Economy
For the first time this year, the number of jobs shrank in June. Long-term unemployment is worse than at any time since the Great Depression. Republican senators inexplicably blocked an extension of benefits. At least last year’s economic stimulus program is creating some jobs. On Friday, two Vermont telecommunication organizations were awarded $47 million to develop a broadband network. The grants are part of a $7.2 billion broadband investment that Congress and President Obama crafted as part of last year’s American Recovery and Reinvestment Act. To read more, click here.
What’s Your Opinion?
Do you support or oppose a moratorium on drilling for new oil supplies in currently protected areas off shore? Would you favor or oppose Congress passing new legislation this year that would provide additional government spending to create jobs and stimulate the economy? To take the latest survey, click here.
MoveOn.org’s Top 10 Corporate Outrages
You can sign a petition:
PLEDGE: Want corporations out of our democracy? Sign it the petition here:
http://www.fightwashingtoncorruption.org/?id=21637-8265398-rf8nUex
1. Exxon Mobil made billions in profits, and yet paid not one dime in federal income taxes in 2009.2
2. The 2005 energy bill had a little known provision, commonly called the Halliburton Loophole, which exempted natural gas drilling from the Clean Water Act. The result? Water so contaminated that you can light it on fire.3
3. Massey Energy was cited more than 2400 times for safety violations in its mines, but chose not to fix potentially lethal problems because low penalties meant it was cheaper to simply keep paying the fines. This spring, 29 miners were killed in an underground explosion at a Massey mine in West Virginia.4
4. Michael Taylor was the FDA official who approved the use of Monsanto's Bovine Growth Hormone in dairy cows (even though it's banned in most countries and linked to cancer). After approving it, he left the FDA—to work for Monsanto. Until last year, when he moved back to the government—as President Obama's "Food Safety Czar." No joke.5
5. Internal Toyota documents outline how the company was successful in limiting regulators actions in the recalls last year—saving hundreds of millions while the death toll continued to climb.6
6. GE and its lobbyists—including 33 former government employees—have successfully lobbied Congress to override Defense Department requests to cancel a GE contract to work on a new engine for the Joint Strike Fighter jet. GE will need $2.9 billion to finish the project.7
7. Top executives at 9 big banks including Citibank, Bank of America, Goldman Sachs, and Morgan Stanley paid themselves over $20 billion in bonuses just weeks after taxpayers bailed them out to the tune of 700 billion dollars.8
8. During the waning days of the Bush administration, officials responded to a long-term lobbying campaign by pre-empting product liability lawsuits for dozens of entire industries. They bypassed Congress entirely and rewrote rules ranging from seatbelt manufacturing regulations to prescription drug safety.9
9. Sunscreen manufacturers including Johnson & Johnson and Schering-Plough, in the interest of profits, are opposing an FDA proposal requiring full reporting on sunscreen labels. The New York Times just confirmed that current SPF ratings don't even measure sun rays that cause cancer.10
10. BP—a company with a record of 760 drilling safety and environmental violations—was granted safety waivers in order to operate the deepwater drilling rig that ultimately created the worst environmental disaster in US history.11
Think this list will make your friends' blood boil? Share it with them on Facebook and Twitter or forward this email ask them to endorse the Fight Washington Corruption Pledge:
http://www.fightwashingtoncorruption.org/?id=21637-8265398-rf8nUex
Thanks for all you do,
–Ilyse, Robin, Milan, Amy and the rest of the MoveOn team
Sources:
1. "BP's latest plan succeeding, but may make spill worse," Newsweek, June 2, 2010.
http://www.moveon.org/r?r=88880&id=21637-8265398-rf8nUex&t=5
2. "GE, Exxon Paid No U.S. Income Taxes in 2009," ABC News, April 6, 2010
http://www.moveon.org/r?r=89262&id=&id=21637-8265398-rf8nUex&t=6
3. "Why is Dick Cheney Silent on the Oil Spill?" Newsweek, June 10, 2010
http://www.moveon.org/r?r=89263&id=21637-8265398-rf8nUex&t=7
4. "Other Massey Mines Showed A Pattern Of Violations," NPR, April 13, 2010
http://www.moveon.org/r?r=89264&id=21637-8265398-rf8nUex&t=8
5. "Monsanto's man Taylor returns to FDA in food-czar role," Grist, July 8, 2009
http://www.grist.org/article/2009-07-08-monsanto-FDA-taylor/
6. "Toyota tried to cut costs on recalls," Los Angeles Times, February 22, 2010
http://www.moveon.org/r?r=89265&id=21637-8265398-rf8nUex&t=9
7. "GE vice chairman openly challenges Gates over F-35 fighter jet engine," The Hill, June 17, 2010
http://www.moveon.org/r?r=89266&id=21637-8265398-rf8nUex&t=10
8. "Bankers Reaped Lavish Bonuses During Bailouts," The New York Times, July 30, 2009
http://www.nytimes.com/2009/07/31/business/31pay.html
9. "Bush Rule Changes Curtail Rights of States, Consumers," Wall Street Journal, October 15, 2008
http://www.moveon.org/r?r=89267&id=21637-8265398-rf8nUex&t=11
10. "UVA Reform: It's Not PDQ," The New York Times, June 23, 2010
http://www.moveon.org/r?r=89268&id=21637-8265398-rf8nUex&t=12
11. "BP's latest plan succeeding, but may make spill worse," Newsweek, June 2, 2010.
http://www.moveon.org/r?r=88880&id=21637-8265398-rf8nUex&t=13
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Wealthy Reap Rewards While Those Who Work Lose
Published on Friday, July 9, 2010 by Inter Press Service | by Adrianne Appel | Link
BOSTON - Times are tough for workers in the U.S. where a recession has a stranglehold on much of the economy, but life is perfectly rosy for those at the top.
The riches of the wealthiest North Americans grew by double digits in 2009, primarily from interest their money earned when it was invested in the stock market and elsewhere, according to a report by the Boston Consulting Group.
Millionaires in the U.S. and Canada saw their wealth increase 15 percent in 2009, to a total of 4.6 trillion dollars, the report found.
Worldwide, 11 million - or less than 1 percent of all households - were millionaires in 2009. They owned about 38 percent of the world's wealth or 111 trillion dollars, up from about 36 percent in 2008, according to Boston Consulting Group.
About 4.7 million millionaires live in the U.S., four percent of the population and more than anywhere else in the world. Japan, China, Britain and Germany followed the U.S. in the number of millionaires.
Their fortune is a stark contrast to the lives of more than 15 million people in the U.S. who are unemployed and searching for work, and the eight million more who are just getting by with a part-time job, according to the U.S. Bureau of Labor Statistics. More than two million more people were working prior to the recession but have now dropped out of the labour force.
Apart from the newly unemployed, about 39 million people in the U.S. are chronically poor and do not have enough food to eat, according to the U.S. Census and U.S. Department of Agriculture.
"The nation's jobs crisis is so catastrophic that, unless Congress acts on the scale of the New Deal, millions of Americans will experience extremely long periods of unemployment for many years ahead," Lawrence Mishel, president of the Economic Policy Institute, told a panel of the Committee on Ways and Means recently.
Not so for millionaires and the uber-rich.
The uber-rich, those with more than 30 million dollars, are on the rebound. They spent more money in 2009 on fancy cars, yachts and jets compared to 2008, according to a study by Merrill Lynch-Capgemini. They bought fine art, expensive jewelry, gems and antiques, items that are likely to increase in value over time, so they can sell them later and make more money.
The recession isn't hitting those at the top as it has workers. In fact, many wealthy people benefited from the stock market's ups and downs, said Mike Lapham, director of the Responsible Wealth Project at United for a Fair Economy, an NGO in Boston.
"Folks at the top have a cushion, a disposable income to fall back on. Maybe their portfolios took a hit but they didn't lose their jobs and their homes. If they had losses, they can deduct them from their taxes," Lapham told IPS.
"Some people bet successfully on the financial system going under," he said. "The stock market went from 10,000 to 6,000 and back to 11,000. That's a big jump for people with significant portfolios."
"The people at bottom who've lost work, it'll be years before they get back to where they were before the crash," Lapham said.
The U.S. average national unemployment rate is 9.7 percent. Only those who are actively looking for work are included in this statistic. Among Black Americans, the rate is 15.5 percent and Latinos, 12.4 percent, according to the Bureau of Labor Statistics. The Congressional Budget Office predicts that unemployment will remain almost unchanged in 2011, about 9.5 percent.
Many families have been surviving on small, weekly unemployment checks provided for 26 weeks by their state government, and an additional 73 weeks by the federal government. The first group of unemployed to run through both benefits hit that point Jul. 1, and today about a million people are receiving no assistance at all. About nine million more are still receiving unemployment payments.
Congress is considering extending federal assistance for another 20 weeks. The House approved the legislation, but the Senate did not. Congress left town for its holiday break until mid-July without passing the legislation.
In the Senate the issue fell almost precisely along party lines, with all but one Democrat for extending the benefit, and all but two Republicans against it, saying the 34- billion-dollar cost was not worth adding to the federal deficit.
Without the vote of Democratic Senator Ben Nelson, of Nebraska, the bill was one vote short of the 60 needed for passage. "I think we're going to see a new wave of heartache here in Rhode Island," with the end of the federal assistance, Kate Brewster, executive director of the Poverty Institute, a Rhode Island NGO, told IPS.
The small, northeastern U.S. state, a former manufacturing centre whose jobs moved offshore, has struggled with higher unemployment and low-wage jobs for years. Most recently, it was hard hit by the foreclosure crisis and the downturn in the construction industry.
The ongoing unemployment and low jobs creation nationwide is helping to fuel the millions of foreclosures sweeping across the nation, according to a report by the Harvard University Joint Center for Housing Studies.
The nation's anemic jobs creation, high foreclosures and weak consumer spending has convinced Mishel and many economists that the U.S. is in for an extended downturn. Just 83,000 jobs were created in June, instead of the 150,000 needed for robust employment, according to the U.S. Labor Department.
"The United States is undergoing the worst economic downturn in 70 years, and the damage and suffering it is causing will last many years beyond the official end of the recession," Mishel said.
Rhode Island's future is uncertain.
"We've consistently had one of the highest rates of unemployment in the country," Brewster said. Today, in the midst of the recession, more people are showing up at soup kitchens for free meals and dialing in to a toll-free, crisis phone service for families in dire circumstances, she said.
"They've had an enormous influx of calls in the past 18 to 21 months," she said. Fewer services are available to help them.
"Within last five years the state cut back work support programmes like child care assistance and funded health insurance," Brewster said. "The cruel irony is that when families really need help, less is available."
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