Flint and lead screenings

One of the things that puzzled me about the Flint lead poisoning is why the problem took so long to identify.  Medicaid gives strong incentives to managed care organizations to test their pediatric members for lead poisoning.  Michigan has their own lead policy:

All Medicaid enrolled children are considered to be at high risk for blood lead poisoning. In accordance with the Centers for Medicare and Medicaid Services guidelines, Michigan Medicaid policy requires that all Medicaid enrolled children be blood lead tested at 12 and 24 months of age, or between 36 and 72 months of age if not previously tested.

Public Act 55 of 2004 required that by October 1, 2007, 80% of Medicaid enrolled children were to have been blood lead tested. MDCH designed a report, theMedicaid Blood Lead Testing report, to monitor compliance with this law.

The January 2013 report showed that there were 3,000+ kids in Medicaid under the age of 2  in Genesee County.  70% of those kids had a lead screening.

Someone should have been screaming that the Medicaid pediatric population was seeing a massive lead level spike.  It should have been either at the provider level, or more readily, at the insurer level as they should have been seeing the claims for follow-up visits after positive lead tests started to come back in high numbers.  And if the providers and insurers were not screaming their heads off, the Michigan medicaid administrative offices should have been as soon as they started to see the claims come across their data encounter system.

Unfortunately, it looks like the state of Michigan put their head in the sand (via the ACLU)

In a posting Monday on the website FlintWaterStudy.org, Virginia Tech professor Marc Edwards accused the state of neglecting the lead-poisoning issue even though Michigan officials knew as early as summer 2014 that there was a problem.

“They [Michigan Department of Human and Services officials] discovered scientifically conclusive evidence of an anomalous increase in childhood lead poisoning in summer 2014 immediately after the switch in water sources, but stood by silently as Michigan Department of Environmental Quality (MDEQ) officials repeatedly and falsely stated that no spike in blood lead levels (BLL) of children had occurred,” wrote Edwards

Lead poisoning is something that should be picked up through multiple systems.  I can’t figure out why the public health system failed so obviously.

Risk Corridors, asset valuation and favoring incumbents

Nicholas Bagley at the Incidental Economist  argues that insurers will eventually be made whole on risk corridor payments even if the money is never appropriated by Congress.

At Rubio’s insistence, Congress in 2014 passed a budget bill prohibiting the administration from using other funding streams—the budgetary equivalent of looking under the couch cushions for change—to make up for any shortfall.

Rubio’s bill has now come back to bite the administration. On October 1, HHS announcedthat, for 2014, health plans were owed substantially more under the risk corridor program than they paid in. Unprofitable plans will thus receive just 12.6% of what they were supposed to….

there’s another option, one that hasn’t received much attention. When Congress creates an entitlement directly in legislation, the person who’s supposed to get the entitlement can file a lawsuit in the Court of Federal Claims to recover what she’s owed.  That’s why plans should still be able to get their cost-sharing reductions, even if the House of Representatives prevails in its case over whether an appropriation exists to cover the cost-sharing reductions.

The same principle holds (1) where Congress vests a federal agency with the power to obligate the United States to make certain payments and (2) the agency welches on those obligations. Here, the ACA instructs HHS to create a risk corridor program requiring the government to pay health plans a given amount of money. If the past is any guide, plans should be able to sue if HHS doesn’t pay them in accordance with the program. That’s so whether or not Congress has appropriated money to fund the program.

If I am understanding the argument correctly, PPACA tells HHS to pay, money is not appropriated, but the money is still owed, so the full faith and credit of the United States government comes into question if the government does not pay. Therefore, once insurers start suing when it is obvious that they will not be made whole for 2014 risk corridor payments, they’ll win easily in court and the government will pay.

That is good news in the long run for well capitalized insurers.   It is bad news for everyone else. Read more

The Super-Genius Shitweasel Strategy (Updated — Open Thread)


Today’s Supreme Court decision on Obamacare makes the law about as settled as it can be given that congress and most statehouses are run by hairspray-huffing shitweasels who occupy an alternative dimension where “flush billions down the toilet” = “fiscal conservatism.”

Shortly after the Supreme Court decision today, our shitweasel governor here in FL announced that he’s dropping a lawsuit he filed against the Obama administration in an attempt to extract a $2 billion handout via a low-income care program — after declining to expand Medicaid to the 800K Floridians who would qualify under Obamacare.

TALLAHASSEE — Florida Gov. Rick Scott is dropping a lawsuit against the Obama administration after reaching an agreement over federal hospital funds.

State and federal health officials reached an agreement in principle earlier this week to continue funding Florida’s hospital low-income pool for two more years, but at a lower cost. Florida will receive $1 billion this year — about half of what the state had been receiving — and $600 million next year. In a statement Thursday, Scott said his lawsuit was essential to getting the funds extended.

Scott’s lawsuit accused the federal government of tying the funds to whether or not the state expanded Medicaid.

The Obama administration and the Florida Senate wanted to expand Medicaid to roughly 800,000 Floridians. But Scott and Florida House Republicans opposed to taking money tied to so-called Obamacare.

Yes, you read that right: These morons turned down $6 billion or so annually because it has Obamacare cooties but were prepared to go to court to shake the feds down for a relatively paltry $2 billion. As a result of this super-genius bluffing strategy, Scott got $1 billion this year and $600 million next year, and he deems it a victory for fiscal prudence.

As far as I know, Scott hasn’t yet outlined his double-secret negotiating strategy for next time the money dries up, which will be 2017. God willing, President Hillary will send him home pants-less with a $400K mortgage note on Stately Scott Manor. This would all be laughable if people weren’t literally dying because of Scott & Co.’s pigheadedness.

ETA: Open thread for anyone who wants to use it for one. We’ve had a lot of Obamacare threads today. In other news, the AP says Chris Christie is going to announce a run on Tuesday. They’re gonna need a bigger clown car (and no, that’s not a fat joke — there are just so MANY clowns!).

Squeezing Blood From A Particularly Poor Stone

Arizona is one of 22 states facing a budget shortfall for fiscal year 2016 (surprise, most of them have Republican governors and/or legislatures) and in tried and true tradition, the Grand Canyon State’s billion-dollar budget hole is going to be plugged by tossing in those awful Poors.

Facing a $1 billion budget deficit, Arizona’s Republican-led Legislature has reduced the lifetime limit for welfare recipients to the shortest window in the nation.

Low-income families on welfare will now have their benefits cut off after just 12 months.

As a result, the Arizona Department of Economic Security will drop at least 1,600 families — including more than 2,700 children — from the state’s federally funded welfare program on July 1, 2016.

The cuts of at least $4 million reflect a prevailing mood among the lawmakers in control in Arizona that welfare, Medicaid and other public assistance programs are crutches that keep the poor from getting back on their feet and achieving their potential.

“I tell my kids all the time that the decisions we make have rewards or consequences, and if I don’t ever let them face those consequences, they can’t get back on the path to rewards,” Republican Sen. Kelli Ward, R-Lake Havasu City, said during debate on the budget. “As a society, we are encouraging people at times to make poor decisions and then we reward them.”

I wonder which red state will be the first to eliminate TANF altogether, since we’re busy freeing the Poors from their plight of dependency. Also, $4 million in saving achieved, and $996 million to go. Certainly Arizona can find some more ways to punish people for the crime of being impoverished in a red state.

Cutting off these benefits after just one year isn’t fair, said Jessica Lopez, 23, who gave birth to her son while living in a domestic violence shelter and has struggled to hold onto jobs because she has dyslexia and didn’t finish high school.

“We’re all human,” said Lopez, who got $133 per month for about a year until she qualified for a larger federal disability check. “Everybody has problems. Everybody is different. When people ask for help, we should be able to get it without having to be looked at wrong.”

There are millions of angry Real Muricans out there who openly dispute Ms. Lopez’s status as “human” and don’t believe she and her son qualify for a myriad of reasons.

Arizona’s Legislature cut the budgets of an array of programs to meet the governor’s no-tax-increase pledge. The bill that included the welfare cuts received overwhelming support earlier this spring from Republicans, with just one Democrat voting in favor.

The Legislature also passed a law seeking to force anyone getting Medicaid to have a job, and cutting off those benefits after five years. And Republican leaders are suing their own state to block a centerpiece of President Barack Obama’s health care law, which expanded Medicaid to give more poor people health insurance.

If they prevail, more than 300,000 poor Arizonans could lose their coverage.

Republican Gov. Doug Ducey’s office called all these cuts necessary to protect taxpayers and K-12 classrooms — even though the source of the money is the federal government.

And of course Republicans want to abolish the Department of Education and end that federal money going to states for schools. And 300,000 people losing health insurance certainly won’t be a long-term problem for an aging state like Arizona.

After all if those awful Poors die or move somewhere else, they’re no longer Arizona’s problem, are they?

Can the Kochs Deliver the Mail Better than Florida Man?

kochrepAs I mentioned in comments on a thread yesterday, the Florida mailman who landed a gyrocopter at the US Capitol to draw attention to the corrupting influence of money in politics lives in the same media market I do and had informed a local paper of his plans prior to taking off. His stunt is therefore receiving more attention and in-depth coverage here than elsewhere.

The mailman is disappointed that the national corporate media outlets are focusing almost exclusively on the security vulnerabilities his flight revealed rather than the two-page campaign finance document he prepared for each congresscritter. The local outlets, having access to the mailman and greater interest due to the regional angle, are covering the campaign finance aspect. Not in sufficient depth, but at least they aren’t ignoring it altogether. The mailman won’t let them. Read more

Cause and effect in Louisiana

A major hospital in Baton Rouge, Louisiana is closing its emergency room because it is hemorrhaging money:

 Baton Rouge General Medical Center-Mid City will close its emergency room within the next 60 days, a victim of continuing red ink and the Jindal administration withdrawing the financial support that kept it open….

The closest emergency rooms from Baton Rouge General’s Mid City campus is Lane Regional Medical Center, 30 minutes to the north in Zachary, and Our Lady of the Lake Regional Medical Center, 30 minutes to the south on Essen Lane. Mid-City’s ER recorded 45,000 patient visits last year…..

More and more poor and uninsured patients from the low-income neighborhoods of north Baton Rouge ended up at the Mid City hospital, which was the next-closest facility.

Mid City hospital reported losses of $1 million a month as more and more patients who could not pay arrived…. Officials projected losses would grow larger, reaching $25 million to $30 million in 2015.

Poor people can’t pay full freight nor are they likely to be covered by insurance. There just happens to be an extremely attractive offer to get lots of poor people covered by insurance. Medicaid expansion would help safety net hospitals in high poverty areas the most. Poor people covered by insurance will either be able to pay something towards their emergency room visits or divert to lower levels of appropropriate care.

Read more

Like A Kansas Tornado

Storm system Brownback continues to ravage the state of Kansas unabated, and the next casualty involves some good old fashioned school austerity bombing.

Kansas Gov. Sam Brownback’s proposed budget cuts about $127.4 million from state support to local school districts, according to a report released Tuesday by the state Department of Education.

Some Senate Republican leaders dispute that the cut is that deep, saying the Education Department figure doesn’t account for spending on bonds and interest for school construction or payments to the state retirement fund.

The governor’s plan, released Friday, is to roll four major categories of spending into block grants to school districts. The block grants will include the money now spent in general state aid, supplemental state aid, capital outlay aid and the school district finance fund.

This year’s budget for those categories is almost $3.14 billion. The block grants proposed by the governor would total slightly more than $3 billion.

Block grants for schools that are already badly underfunded to the point where the state supreme court ordered Brownback to spend more, huh.  This should go over well.  Oh, but here’s the best part.

More broadly, Kansas state workers’ pension funds are also being used to patch Brownback’s fiscal gap. He is proposing to cut state payments to pension funds by $446 million over three fiscal years including the current one while also refinancing some of the funds’ debts. But the executive director of the Kansas Public Employees Retirement System says Brownback’s proposed tweaks will ultimately cost the state more than 8 times what they save in the short term.

The near-term cuts would raise long-term costs by $3.7 billion — nearly a quarter of the current size of the pension system. Reneging on pension obligations in the short term and creating larger retirement system problems in the long term helps create political pressure to cut workers’ retirement benefits down the road, according to critics of similar maneuvers in states like New Jersey.

Another big-ticket Brownback cut strips roughly $300 million in transportation department funding over the next couple years — a move that shares the penny-wise, pound-foolish DNA of Brownback’s schools and pensions cuts. The road repair cuts will save a little bit of money now, but “all you’re going to do is create bigger problems for yourself later,” the head of a trade group for heavy construction firms in Kansas City told the Star.

And that’s on top of his plan to raise cigarette and liquor taxes so he can keep cutting the state’s income taxes, which caused all this mess in the first place.

If you want to see what a Republican budget will do to the country should they get control of the whole playing field in 2016, look no further than the tornado ripping through Kansas right now.