Tag Archives: Medicaid

The Governor prepares a soft landing

Is Peter Shumlin starting to act like a lame duck? It would seem so. To judge by this week’s paltry trinkle of news, he looks to have one eye fixed on the past and the other on his post-gubernatorial future. And he’s already given up on fixing one major debit in his administrative ledger.

As VPR’s Bob Kinzel reports, Shumlin opposes any tax increases to pay for Vermont’s burgeoning Medicaid bill, but he doesn’t want to cut eligibility or benefits either. In fact, he’s washing his hands of the whole mess.

“I don’t know which governor is going to get to solve this problem,” he added. “But I hope a governor gets to solve it soon.”

“…once I’m safely ensconced in the private sector with my lissome new bride,” he might have added under his breath.

Yeah, screw the 2016 session. The Governor, you see, proposed a Medicaid fix last year and the Legislature ungratefully rejected it. So he’s done his duty, and hereby washes his hands of the matter.

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Another conveniently incomplete explanation from Art Woolf

Just in time for Christmas, Vermont’s Loudest Economist has left a flaming bag of conventional-wisdom poo on our doorsteps. (At least he didn’t try to come down the chimney.)

He’s scribbled out a column entitled “Explaining Demise of Single-Payer.” Which, of course, does virtually nothing to explain the demise of single-payer. I mean, this is Art Woolf we’re talking about here.

The good professor spends most of his time on a shallow meander down Memory Lane, explaining that despite the efforts of the last three Vermont Governors, our percentage of uninsured Vermonters has remained basically the same.

Of course, Woolf’s entire argument falls apart right there, because his beloved statistics end at 2013 — before the Affordable Care Act had gotten off the launchpad. So he’s telling us that Shumlin has failed to reduce the uninsured population, even though Shumlin’s reforms hadn’t begun to work.

Sheesh.

Woolf goes on to the only useful part of his “analysis.” In recent years there have been efforts to expand Medicaid eligibility, and they have worked. However, there’s been a corresponding decline in coverage through employers, so it all washes out.

Us liberals would blame this on a worldwide, concerted effort to drive down wages and benefits — the race to the bottom, as revealed in the stagnation of buying power for all but the very top earners, the persistent crappening of benefits such as employer-provided health insurance (and the steady cost-shifting to employees by way of worker contributions, high deductibles and copays) and the virtual disappearance of defined-benefit pension plans.

Woolf, good capitalist lackey that he is, blames the loss of employer health insurance on the expansion of Medicaid.

What apparently has happened during the past 15 to 20 years is that some employers who formerly provide insurance to their workers no longer provide that benefit. Most likely, it’s because their employees can get a better coverage plan at no or low cost from the state.

“What apparently has happened,” my ass. Woolf might be justified in making that evidence-free assumption, if not for all the other evidence that employers are squeezing their workers and transferring responsibility for their well-being to the government. (See: all the Walmart employees on some form of public assistance. I guess Woolf would blame that on welfare, not on a greedy corporation.)

The toxicity of Woolf’s presentation becomes clearer in th;e ensuing paragraph:

Their employers can therefore afford to pay their workers higher wages instead of providing health insurance benefits. This is one of the unintended consequences of government policies that are all-too-often overlooked by policymakers.

Well, sure, they CAN afford to pay higher wages. But they DON’T. And Woolf knows damn well that they don’t. He must be aware that working Americans’ wages have been stagnant for decades.

And he must be deliberately excluding that fact from his presentation so he can preserve his dubious conclusion: government largesse is to blame for private-sector miserliness. If not for Medicaid expansion, he is effectively saying, working Americans would still be getting health insurance from their employers.

Working Americans can only respond with a bitter laugh.

He also blames Medicaid for the rising cost of health care: because Medicaid offers low reimbursement rates to providers, they have to charge more to private insurance carriers. Which is true, but again, it leaves employers out of the equation.

Finally, in the last paragraph of Woolf’s column, we get to “Explaining the Demise of Single-Payer.” Sort of:

The state’s Medicaid expansion now provides a backstop for lower- and middle-income Vermonters who might lose their private health insurance. This means the third goal, the fear of becoming uninsured, might have lessened over time for many Vermonters.

Perhaps that’s one reason why there wasn’t greater support for single-payer in Vermont, and why there wasn’t more opposition to the governor’s recent announcement.

Oh, so we should blame the demise of single-payer on the patchwork success of Medicaid? Nothing else at play here, Art?

To be fair, Woolf doesn’t necessarily write the headlines, so maybe he’s not responsible for the vast overpromise of this one. But he is responsible for the incomplete, one-sided “logic” that resides beneath.

Art Woolf’s weekly words of wisdom usually come to us on Thursdays. This one was published on Wednesday. Perhaps tomorrow, on Christmas Day, Woolf will favor us with his reasoned defense of Ebenezer Scrooge, and how the government’s generous provision of prisons and workhouses helped drive down wages in Victorian England.

$20,000,000 is the least of our problems

Big scoop came out Friday. As first reported by VPR’s Peter Hirschfeld, the still-troubled Vermont Health Connect could cost the state as much as $20 million extra this fiscal year — for expenses that the federal government might decide not to cover.

The story got some legs, although it came out in the journalistic dead zone of Friday afternoon. It was picked up by other outlets and became kind of a big deal.

And it was the best possible thing that could have happened to the Shumlin Administration. 

Why do I say that? Because it sucked the oxygen out of that particular room, leaving a much bigger VHC story flailing in its wake. (Mixed metaphor? Sorry.)

The story, by VTDigger’s Morgan True, included the $20 million bit, but also revealed a host of other problems with VHC. The story paints a bleak picture of a system still in disarray, and facing big new challenges in less than two weeks.

The problems, in rough order of appearance in True’s narrative:

— The VHC website will be up and running in time for the new open enrollment period, which starts on Nov. 15. But previously insured customers seeking to renew will be asked to stay away from the website and instead fill out a paper form and submit it by mail. The reason: More of this year’s “customer service frustration” is expected by health care reform chief Lawrence Miller. Great.

— As open enrollment looms, there’s still “a mountain of old problems” that will be impossible to resolve by the 15th. So the masters of health care have come up with a kludge: they’ll keep the old cases active with tricks like fake zip codes, even as they’re working on new cases.

Gee, that sounds like a sure-fire plan. Nothing can go wrong with loading fake zip codes into an already wonky system, can it?

— The state’s contract with its new contractor, Optum, hasn’t been renewed yet. If it’s not by the end of business Monday, the company won’t continue to work and “‘Vermonters will not be renewed and will lose coverage,’ according to a document obtained by VTDigger.”

— The state has failed to keep up with required income verifications for “thousands of Medicaid beneficiaries,” which is “a growing concern of the feds.” If some recipients turn out to be ineligible, the state could be on the hook for their medical bills.

— This is more of a problem than you might think because “during the past year, people were hastily added to the state’s Medicaid rolls in order to close out their cases and get them off the hands of overworked employees,” according to the anonymous VHC worker.

— One anonymous VHC worker reported internal problems with Optum employees making mistakes, being poorly trained, being shuttled in and out of state frequently, and “a lack of ownership on the part of mid- to lower-level state employees,” who believe that if the system fails, Optum will take the heat.

— The motives of Optum and other contractors are being questioned by a top VHC official, who pointed out in an Oct. 15 memo that the contractors “have financial motivation to protract their term of employment… to generate profit.” He says the state needs to find a path forward that gives contractors a reasonable profit but ensures that Vermont doesn’t pay too much.

— “Many of the state employees… are temporary workers.” Some have been working on VHC for over a year, which is far longer than is allowed for temp staff. Unlike regular, unionized state employees, the temps don’t get any benefits, just a straight hourly rate.

— Because some coverage has tax implications and VHC staff are not trained in that area, there’s a fear that thousands of VHC customers could find themselves with an unexpected tax bill come April.

This is all on top of the potential $20,000,000 shortfall. Which is bad enough, but now you know why I say the Shumlin Administration should thank its lucky stars that it was Hirschfeld’s story that got spread around and not Morgan True’s far more detailed, far more damaging one.