In an altruistic outreach to states feeling the burden of increasing Medicaid expenses -- on top of all the salaries they have to pay those greedy teachers and cops -- the Health and Human Services Secretary has written a letter to all 50 governors reminding them that several optional programs covered by Medicaid are.... well, optional.
Pssst.... says Kathleen Sebelius. Just between us - you don't really have to cover people for dental work, physical therapy, all those expensive drugs, eyeglasses. You can even drop people from coverage entirely! Or make them help pay for things themselves! So much health care is just so darned wasteful. The letter reads, in part:
".... States have substantial flexibility to design benefits, service delivery systems, and payment strategies, without a waiver. In 2008, roughly 40 percent of Medicaid benefits spending – $100 billion – was spent on optional benefits for all enrollees, with nearly 60 percent of this spending for long-term care services. The enclosed paper identifies a range of State options and opportunities to more efficiently manage Medicaid, many of which are underway across the country. Some of the key areas of potential cost savings are described briefly below:
•Modifying Benefits. While some benefits, such as hospital and physician services, are required to be provided by State Medicaid programs, many services, such as prescription drugs, dental services, and speech therapy, are optional. States can generally change optional benefits or limit their amount, duration or scope through an amendment to their State plan, provided that each service remains sufficient to reasonably achieve its purpose. In addition, States may add or increase cost sharing for services within limits (see attachment for details). Some States have opted for more basic benefit packages for higher-income enrollees (e.g., Wisconsin provides benefits equivalent to the largest commercial plan offered in the State plus mental health and substance disorder coverage for pregnant women with income between 200 and 250 percent of poverty). A number of States charge beneficiaries $20 for non-urgent emergency room visits or use cost sharing for prescription drugs to steer individuals toward generics or preferred brand-name drugs."
Translation: You just heard it from the top. Guvners - get out your axes and your chopping blocks, and get to work instead of asking for waivers and bitching to me! We all need to tighten our belts, except for me and other high-ranking government officials and rich people and multinational corporations. Poor people don't have clout, so they shall be the first to suffer, saith the Obama Administration.
Needless to say, some people who are still considered true Democrats are stark raving livid over the Sebelius missive.
"When you consider that – in a for-profit healthcare system, about 30 percent, and as much as 33 percent, of all spending goes for corporate profits, stock options, executive salaries, advertising, marketing, processing paperwork – it's cruel!" said Dennis Kucinich, D-OH, of the Sebelius letter. Kuninich is a longtime proponent of Single Payer Health Care, or Medicare for all.
Sebelius had written in response to an earlier letter last month from 33 governors asking her to lift a provision of the new reform law – called the maintenance of effort (MOE) requirement – preventing states from trimming Medicaid rolls ahead of the Affordable Care Act's broad 2014 expansion.
Mary Kahn, spokeswoman for the Centers for Medicare and Medicaid Services (CMS), issued a denial that the letter was a barely disguised set of instructions to states on how to drop people from coverage.
Regarding dental coverage, what is covered varies widely from state to state. In New York, Medicaid will not pay for root canals. Poor people on Medicaid who can't come up with upwards of $1000 for that procedure instead have to opt for an extraction of a tooth that could otherwise be saved. In California, Medicaid no longer pays for dentures. And since the majority of Medicaid recipients are the elderly (not the mythical Reagan Cadillac welfare queens the politicians love to rail against), there are going to be an awful lot of people walking around who literally can no longer eat. But maybe that's the plan. Despite the health care reform act, more people are uninsured now than when the law took effect. Benefits are decreasing and premiums are skyrocketing. But the insurance companies who sell the junk policies are posting record profits, as are the drug companies. The president agreed not to negotiate lower prices with Big Pharma in exchange for their not fighting him on health care legislation - or, more accurately, private health insurance practices legislation.
And what does Obama think about the government covering dental procedures under health care reform? During a town hall in Las Vegas last year, a dentist asked him that very question. His response, accompanied by his million-dollar smile, was "Everybody floss!"
WTF. As far as I'm concerned, everybody's been fleeced.
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