According to media reports, Georgia is asking the federal government to let it become another state to push the cost of providing healthcare to the children of state employees on the backs of federal taxpayers. The Centers for Medicare and Medicaid Services (CMS) has already approved this process for Montana, Alabama, Texas, Kentucky and Pennsylvania.

These states are seeking to push the kids of state employees into the CHIP program, a federal program originally designed to provide health care to kids in lower income families. But this latest move by the states seeks to expand coverage well beyond what the federal program was designed to accomplish.

The national implications of the states attempting to do this are numerous, including:

1. Taxpayers in other states will now be forced to finance the cost of state government in another state through their federal tax dollars. This is unfair to taxpayers nationwide.
2. This will also reduce the incentive for states to fund the benefits they promise and to live within their means.
3. This will lower incentives for states, like Texas and Georgia, to actually come up with appropriate budgetary savings and to live within its means.  For example, Gov. Mitch Daniels (IN) has moved his state employee health plan to HSAs which has reduced the burden on taxpayers and created market incentives for state employees to make better health care decisions.   
4. ObamaCare expands CHIP while reducing the applicable pool of participants in the private insurance market. In this regard, the states that are attempting this maneuver are further reducing that pool which could have negative affects on everyone who relies on private insurance in that state.
5. Finally, the real implications have to deal with the Health Care Compact. Texas and Georgia have both adopted the compact with the promise it would let states "keep their money" and give states control over health care to design more efficient health care systems. The move by Texas and Georgia shows these states are hypocrites when it comes to the promised goals of the compact. It also shows that the compact is filled with nothing more than empty promises and hot air. Otherwise, the HCCA (which is pushing the compact) would be doing far more to hold elected officials in these states accountable instead of giving them a pass to say one thing while doing another. If anyone should be decrying the move by these states it should be Leo Linbeck III (a resident of Texas and co-chair of the HCCA) but his silence on the issue speaks volumes about how ill-conceived the compact really is.

Be sure to follow AHEC on Twitter @TheAHEC and at Facebook.com/TheAHEC.

U.S. News & World Reports that Medicaid and CHIP patients, particularly children, have trouble accessing specialists - like dentists.  Undercover researchers in Illinois posed as parents seeking urgent dental care for their child.  The researchers found that depending on the kind of insurance (private or government) that it was harder for the patient with government insurance to schedule an appointment.  

The study's coauthor, Dr. Karin Rhoades, attributed the difference on the disparity on Medicaid's reimbursement rates for dental services.  According to USNWR, "In Illinois, Medicaid reimburses dentists 53 percent of their median usual fees, placing the state among 25 others below the national average reimbursement level of 60.5 percent for the same procedures." 

Be sure to follow AHEC on Twitter @TheAHEC and at Facebook.com/TheAHEC.  

On of ObamaCare's worst features is its dramatic expansion of Medicaid that will push people from private insurance to government system that is able to provide less and less care in the face of state budget cuts.  ObamaCare expands Medicaid eligibility from 100% to 138% of the federal poverty level.  But fewer and fewer doctors, particularly specialists, are willing to accept Medicaid due its already low (and shrinking) reimbursement rates.

The New York TImes details the story of how a young boy from Louisiana, who is covered by Medicaid, has been unable to see a specialist psychiatrist for over a year for his behavioral issues.  In Louisiana, state officials estimate that Medicaid will grow nearly 40% in their state as a result of ObamaCare.  This demonstrates the undeniable tension of ObamaCare - adding far more patients who rely on Medicaid at a time when fewer and fewer doctors are willing to treat them.

Among some very telling statements from the NYT article are the following:

• Dr. James B. Aiken, “Having a Medicaid card in no way assures access to care.”
• Nicole R. Dardeau, a nurse unemployed due to an injury, “My Medicaid card is useless for me right now,” and “It’s a useless piece of plastic."
• Dr. Michael A. Felton, “How can an already overtaxed Medicaid system handle such a huge influx of people?”
• Dr. Rachel Z. Chatters, a pediatrician noting how hard it is to find specialists for Medicaid her patients, “I devote one afternoon a week, every Wednesday afternoon, to trying to find specialists for my patients...."
• Bruce Greenstein, secretary of the Louisiana's Department of Health & Hospitals: “We have a hard time finding specialists for Medicaid enrollees.”
  
  

Marking the one-year anniversary of ObamaCare becoming law, the majority staff at the House Ways & Means Committee issued a summary of the bad effects ObamaCare has had over the past year.  Their summary is similar to one put together by AHEC staff earlier this month and published at A Line of Sight.

The Ways and Means (WAM) summary contained the following:

• March 2010: Higher Costs for Employers, Fewer Jobs for Workers & States Revolt
• April 2010: Higher Health Care Spending & Seniors’ Health Care in Jeopardy
• May 2010: Myth of Small Business Credit Dispelled as Employers & More States Join the Repeal Effort
• June 2010: White House Admits You Can’t Keep What You Have and Like
• July 2010: Entire States Seek to Be Exempt from the Democrats’ Health Care Overhaul, Americans Begin Paying Higher Taxes, & Individuals Start Losing Their Health Insurance
• August 2010: Seniors Learn They Will Lose Retiree Prescription Drug Coverage
• September 2010: Employers Forced to Get a Waiver or Cancel Insurance
• October 2010: Workers Forced to Pay Higher Health Care Costs
• November 2010: American People Back GOP Pledge to Repeal 
• December 2010: Law Declared Unconstitutional
• January 2011: Law Again Declared Unconstitutional and Insurance Companies Stop Offering Coverage
• February 2011: Administration Admits to Budget Gimmicks & CBO Says Law Will Mean Fewer Jobs 
• March 2011: While Employers Struggle, Unions & State Governments Get Help; Waivers Total More than 1,000

Details of the WAM analysis can be found here.

As America nears the one-year anniversary of ObamaCare becoming law, AHEC has released a new document entitled: "A Policymaker's Primer on ObamaCare: The Myths, the Costs and a Practical Guide to Defunding the Government Takeover of Healthcare in the 112th Congress."

The following is the Primer's Abstract:

On March 23, 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act, which is commonly referred to as ObamaCare. This law includes a series of provisions that will have a dramatic impact on America’s healthcare system, including: (1) increased taxes and compliance burdens imposed on small businesses; (2) changes to HSAs that make them less useful to individual consumers and increased fines for non-qualified distributions; (3) deep cuts to Medicare Advantage, the free-market portion of Medicare; (4) a significant expansion of Medicaid, which will threaten state budgets; and (5) an unprecedented use of the Constitution’s commerce clause to justify the imposition of an individual mandate requiring individuals to carry health insurance or face serious tax penalties. Supporters of the law have made a series of promises about this law, including that it will reduce costs and expand access to insurance. Opponents of the law, however, note that these promises have proven false, and that the law will actually increase insurance costs, increase federal budget deficits, and damage the U.S. economy. In response to the clearly negative impact the law will have on businesses, individual consumers, and America as a whole, this primer concludes that it is necessary to repeal ObamaCare and recommends a course of action for state and local policymakers to achieve that objective.

The document is available on AHEC's website here and can also be found in the Policy & Analysis area of AHEC's website.

Be sure to follow AHEC on Twitter @TheAHEC and at Facebook.com/TheAHEC.

A survey of state insurers conducted this week by Republican staff on the Senate Health, Labor and Pensions Committee reveals at least twenty states no longer offer child-only policies. The states that have no carriers "currently selling child-only plans to new enrollees" are: 

Alaska
Arizona
Connecticut
Delaware
Florida
Georgia
Illinois
Minnesota
Nebraska
Nevada
New Mexico
North Dakota
Oklahoma
Rhode Island
South Carolina
Tennessee
Texas
Utah
West Virginia
Wyoming

However, Kentucky, Idaho, Iowa, and Ohio did not provide complete data so the actual total of states without child-only policies may be as high as twenty-four.

Politico links the exodus from these policies directly to ObamaCare:

Since September, the health reform law has barred insurers from withholding policies to children under 19 who have a pre-existing condition. Rather than take on the burdensome cost of writing policies for potentially-pricey medical conditions, many carriers decided to leave the market altogether.

To keep even more insurers from fleeing the child-only market, many states - specifically California, Colorado, Indiana, Kentucky, Maryland, New Hampshire, Ohio, and Washington - have enacted legislative and/or regulatory action to encourage the continuation of these policies. Yet even these guidelines cannot ensure that all state providers will continue child health plans.

The Congressional Research Service (CRS) released a report last month detailing the large amount of money contained in ObamaCare to fund implementation over the next ten years.  To those who read ObamaCare before it passed none of these individual spending provisions should come as a surprise.  The noteworthy aspect of the CRS document is that it aggregates these spending provisions, putting them into a concise document which details a vast amount of spending.

This is another problem with ObamaCare, it puts nearly $100 billion of spending to implement ObamaCare on autopilot and makes the job of Congress to conduct oversight regarding implementation harder.  Now that spending is already in motion, it will be harder for Congress to cut spending or withhold spending to gain leverage over the leviathan that is HHS.

AHEC has compiled a brief list of the amount and description of the Appropriations (the page numbers correlate to the hyperlink for ObamaCare contained above):

Section 1002 (page 139) – Consumer Assistance (Grants)
First FY, $30,000,000
Subsequent years, such sums as may be necessary

Section 1003 (page 140) – Federal Takeover of Premium Reviews (Grants)
$250,000,000

Section 1005 (HCERA) – Reform Fund
$1,000,000,000

Section 1101 (page 143) – Administrative Costs of High Risk Pools
$5,000,000,000

Section 1102 (Page 145) – Coverage for Early Retirees
$5,000,000,000

Section 1311 (page 173) – Health Benefits Plans
Blank Check – “amount necessary” to carry out this section

Section 1322 (page 188) – Grants to Create Non-Profit Insurers
$6,000,000,000

Section 1323 (page 195) – Community Health Insurance Option
Such sums as requested by the Secretary
$1,000,000,000

Section 2405 (page 305) – Expansion of A/D Resource Centers
$50,000,000 ($10,000,000 x 5FY)

Section 2701 (page 318) – Adult Health Quality Measures
$300,000,000 ($60,000,000 x 5FY)

Section 2707 (page 327) – Medicaid Psychiatric Demonstration Project
$75,000,000

Section 2801 (page 328) - MACPAC
$11,000,000

Section 2951 (page 343) – Home Visiting Programs
$1,500,000,000

Section 2953 (page 352) – Personal Responsibility Education
$375,000,000 ($75,000,000 x 5)

Section 2954 (page 352) - Education
$250,000,000

Section 3013 (page 384) – Quality Measure Development
$375,000,000 ($75,000,000 x 5)

Section 3014 (page 387) – Quality Measurement
Up to $100,000,000

Section 3021 (page 394) – CMS Innovation
$5,000,000
$10,000,000,000

Section 3024 (page 408) – Demonstration Project
$30,000,000

Section 3026 (page 415) – Transition Program
$500,000,000

Section 3027 (page ____) – Demonstration Project
$1,600,000

Section 3306 (page 470) – Assistance for Low-Income Programs
$300,000,000

Section 3403 (page 506) – Board
$150,000,000 ($15M adjusted annually for inflation)

Section 4002 (page 541) – Prevention Fund
$5,000,000,000

Section 4101 (page 547) – School Based Health Centers
$200,000,000 ($50M x 5)

Section 4108 (page 564) – Incentives to Prevent Chronic Diseases n Medicaid
$100,000,000

Section 4202 (page 570) – Wellness
$50,000,000 transfer

Section 4204 (page 473) – Immunization
$1,000,000

Section 4306 (page 587) – Child Obesity Programs
$125,000,000

Section 5210 (page 615) – Ready Reserve Corps
$100,000,000

Section 5507 (page 668) – Demonstration Projects
$425,000,000 ($85M x 5)
$15,000,000

Section 5508 (page 672) – Teaching Capacity
$230,000,000

Section 5509 (page 675) – Grad Nurse Program
$200,000,000

Section 6201 (page 727) – Background Checks
$160,000,000

Section 6301 (page 728) – Research
(1) Amounts in a fund
(2) $1.26B + trust fund sources (see formula)
(3) Fund based appropriations

Section 6402 (page 761) – Program Integrity
$350,000,000

Section 8001 (page 842) – Class Act
Up to amount collected in a trust fund

Section 9023 (page 883) – Therapeutic Discovery Project
Such sums

Section 10203 (page 931) – Enrollment Prgrams
$40,570,000,000

Secs. 10211-10214 (page 931) – Pregnancy Assistance grants
$250,000,000

Section 10323 (page 959) – Medicare for Hazardous Exposure
$215,000,000

Section 10502 (page 1003) - Facility Construction
$100,000,000

Section 10503 (page 1004) – Community Health Center Fund
$1,500,000,000
$1,500,000,000