The budget debate should be a health care debate, because that’s where all the money goes. We didn’t have a health care debate the last time around, because conservatives spent enormous amounts of time, money and media making sure our health care debate had nothing to do with the health care system we actually have.
Liberty, broccoli, death panels, abortion, state’s rights, the commerce clause, tort reform, anything but the health care system we have. I’m an optimist, so I see an opening. Maybe this time we’ll get around to talking about health care.
I found an article about a governor who is not Chris Christie, although this governor talks about America’s Governor, Chris Christie, which is probably how he snuck into the newspaper.
But Mr. Malloy does not apologize for proposing tax increases. “It’s what’s right for my state,” he said. “Connecticut would not be Connecticut if we cut $3.5 billion out of the budget. We are a strong, generous, hopeful people. We’d be taking $800 million out of education. You can’t do that in this state. You’d have to gouge the Medicaid system. You’d have to close 25 percent of the nursing homes. What do you do with people?”
A fact has entered our budget debate!
He’s talking about nursing homes and Medicaid because he’s telling the truth. He’s talking about dual eligibles (pdf):
Nearly 8.9 million older Americans and younger persons with disabilities participated in both the Medicare and Medicaid programs in Federal Fiscal Year (FFY) 2007. Although
these dual eligibles accounted for only 15 percent of Medicaid enrollment in 2007, 39 percent of all Medicaid expenditures for medical services were made on their behalf. These same individuals also account for more than 25 percent of Medicare spending.
Dual eligibles as a share of total Medicaid enrollees ranged from a low of 10 percent in Arizona and Utah to a high of 25 percent in Maine, due to demographic differences and policy preferences across the states. Similarly, spending on dual eligibles as a percentage of total Medicaid spending ranged from a low of 26 percent in Utah and New Mexico to a high of 59 percent in North Dakota.
70% of Medicaid spending was for long-term care services which are mostly not covered by Medicare or private insurance. Nearly two-thirds of Medicaid spending on dual eligibles was for enrollees age 65 and older. Although only 15 percent of dual eligibles were in an institutional long-term care setting in 2007, these enrollees accounted for more than half of all spending on duals.
Medicaid is going to be in the conservative cross-hairs so I think it’s probably important to talk about where Medicaid money actually goes.
Two more points:
Nearly one quarter (24%) of Medicaid spending for dual eligibles went toward Medicare premiums and cost-sharing and other Medicare services in 2007.
In other words, Medicaid money goes to Medicare.
Forty states have higher Medicaid income levels for nursing home residents than for ordinary Medicaid recipients.
That’s because people who are lower middle class cannot afford a nursing home, as everyone who has ever had to find one knows.
I don’t bring this up this to start some pointless, vicious battle over resources, where we’re all fighting over our allotment of health care. I think that’s the wrong away to talk about health care, because it’s fear-driven and divisive, and leads to months wasted on slippery-slope bullshit like death panels and state-mandated broccoli consumption. We are, after all, “a strong, generous, hopeful people” like Governor Malloy says, and we spend so much on health care now there should be plenty to go around. I raise it because we can’t talk honestly about Medicaid without looking at where nearly 40% of the spending goes, now, in the real world.
If you hear a governor talking about Medicaid and they forget to mention dual eligibles, that’s a solid indication they’re lying to you.