Counties, Old Folks Face Increased Costs Under Senate GOP Health Care Bill

Hey, county commissioners! You’d better call Senators John Thune and Mike Rounds and tell them not to break your budgets with their health care bill:

The Senate bill would lead to even sharper cuts to traditional Medicaid than the House-passed bill due to an adjustment of the growth rate after FY 2025. Cuts to traditional Medicaid and ACA’s Medicaid expansion (explained below) in the House-passed version were already estimated to total $834 billion, or one-fourth of federal funding over the next decade. Under this scenario, states would be forced to cut benefits and/or shift costs to providers or local governments, including counties.

While the Senate bill would further limit the ability of states to use provider taxes to raise revenue for Medicaid funding, counties receive no such protections in the bill. Provider taxes would be annually decreased by 0.2 percent over a five-year window. Therefore, counties would be even more vulnerable to financing a greater proportion of the Medicaid program, while also having to cover uncompensated care costs and/or services for residents that were previously covered by Medicaid [Brian Bowden, “NACO’s Analysis of Senate Health Proposal: Massive Costs for Counties,” National Association of Counties, 2017.06.23].

NACo says the Senate GOP wealthcare bill also hobbles treatment of opioid addiction, erodes quality of insurance, and cuts funding for public health:

The Senate bill would directly impact approximately 1,900 local public health departments by eliminating the Prevention and Public Health Fund beginning in Fiscal Year 2018 (October 2017). This would result in a reduction of almost $1 billion annually for public health investments, much of which goes directly to states and our counties to help us safeguard our residents from infectious diseases like measles or Ebola and prevent the onset or spread of disease. Such loss of funding would further inhibit counties’ ability to respond to public health emergencies and address the underlying causes of poor health outcomes and health disparities amongst our residents [Bowden/NACo, 2017.06.23].

NACo expresses concern that Senate Republicans will leave lots of elderly Americans, especially rural senior citizens, unable to afford nursing home care. The Minnesota Department of Human Services and AARP share this concern:

“There’s a lack of awareness that Medicaid is really the safety net in Minnesota for so many of our seniors,” said Minnesota Department of Human Services Commissioner Emily Piper, whose agency manages the $11 billion program.

…“It’s not just the seniors who rely on Medicaid, their whole family does,” said Piper. “Their adult children, who are working and saving to send their kids to college, or who are raising young children who can’t take on the additional responsibility of providing day-to-day, 24-hour care of aging grandparents.”

…Last year, nearly 30,000 Minnesotans were served by the Elderly Waiver program. The state spent an average of $1,300 to $1,600 per person a month, compared to the average monthly cost of a nursing home of $6,700.

“The proposed cuts will have an unfortunate impact on the progress we’ve made,” said Erin Parrish of AARP Minnesota, citing a recent AARP study that ranked the state No. 2 in care for seniors and their caregivers. “The number of Minnesotans turning 65 this decade will be greater than the past four decades combined. The cap doesn’t keep pace with changing demographics” [Jackie Crosby, “Medicaid Cuts in GOP Health Care Bill Could Take Toll on Minnesota Seniors,” Minneapolis Star-Tribune, 2017.06.24].

That’s funny: Governor Dennis Daugaard is assuring us that his fellow Republicans’ health care plan probably won’t affect the “most frail populations” currently receiving Medicaid. What population is more frail than old folks in nursing homes?

Vice-President Mike Pence sloganeers that “Before summer’s out,” the Republican push to repeal and replace the Affordable Care Act will lead us to a system “based on personal responsibility, free-market competition & state-based reform.” But in practice, the Republicans seem determined to crush county budgets and price Grandma out of the nursing home.

18 Responses to Counties, Old Folks Face Increased Costs Under Senate GOP Health Care Bill

  1. Give them what they voted for.

  2. Looks like Rounds , Thune , Noem way to reduce health care costs is let us die.

    We need two new Senators and one new repsentative in DC

  3. Porter Lansing

    Can someone help me find info on what a provider tax is? I’m having difficulty learning about it. Thanks.

  4. Don Coyote

    @Porter Lansing: Here’s an explanation from the Kaiser Foundation. Hope it helps.

    “Provider taxes are imposed by states on health care services where the burden of the tax falls mostly on providers, such as a tax on inpatient hospital services or nursing facility beds.”

    “States use the additional revenue collected by provider taxes in a number of ways to support Medicaid programs. For example, provider taxes help to support provider rate increases or to help mitigate provider rate cuts. States also have used funds collected from provider taxes to support the Medicaid program more broadly. For example, Colorado used some of the funds raised through their hospital provider fee to expand eligibility to parents and children. During economic downturns, when state tax revenues fall at the same time that demand for public services like Medicaid increases, states are more likely to impose or increase provider taxes to help fund the state share of Medicaid.”

  5. Porter Lansing

    Yes. That helps. Is it a tax on labor but only on labor in the healthcare industry? Since the product they sell is the use of their bed and the labor of their nurses and it’s not a product you take home with you. If I get a car repair and it’s a hundred in parts and a hundred in labor the labor isn’t taxed but the labor and space rental in a hospital has a special tax?

  6. Here is a hint of us old folks, go to prison. Think of it! Free healthcare, Free food, Free cable, Free lodging, plenty of folks to visit with. You can be visited by your relatives. You get to keep your property! Sell your story.

    Before the ACA/Obamacare, there was a bank robbery in Rapid City where the guy stopped at the casino on the South Dakota/Nebraska border. He called the law and turned himself in. He was a very sick man and needed healthcare, it worked out pretty good for him as he received his healthcare and got all the rest of the prison perks as well.

    You would have to go big though. Stealing money from a bank robbery is a good way to do it, or something that has to do with stealing money. The big boys do not like that and above all else, do not take a plea deal. Declare yourself unrepentant. The prison will even pay for your nursing home needs. You are welcome!

  7. Don Coyote

    @Porter Lansing: Some more information from the National Conference of State Legislatures.

    “In general, a “provider tax,” sometimes termed a “fee” or “assessment,” is a state law that authorizes collecting revenue from specified categories of providers. In most states, it is used as a mechanism to generate new in-state funds and match them with federal funds so that the state gets additional federal Medicaid dollars. In a majority of cases, the cost of the tax is paid back to providers through an increase in the Medicaid reimbursement rate for their patient treatment and services. Beyond Medicaid, states have the policy option to tax most types of providers and services and to designate or earmark the revenue for any state purpose. For example several states used similar taxes to fund a state-run high risk pool.”

  8. Porter Lansing

    Thanks Don. I’ve got it, now.
    Good plan, Jerry. Get sick. Go to prison and get treated. OR Get sick. Move to Scotland and get treated. Couldn’t we just get National Healthcare so poor Hickey could come home to his church and be happy?

  9. Old folks do not qualify for a state run high risk pool as they do not have health insurance other than Medicaid or Medicare. As they are destitute, they have Medicaid pay their nursing home stays. No pool for you, they say. The Thune/Rounds/Russian plan is to basically give Medicaid nursing home residents a pill for their health needs as their beds will no longer be paid for by state and federal money. That pill is called cyanide. The good news is you can even purchase this will you are baiting prairie dogs. Kind of a one size fits all as Washington looks at old folks as predators on their wealth.

  10. We have an illegitimate president making laws that will devastate the country.

    59 voting machines all broke on the same day, that is one helluva accomplishment for Putin and those cult republicans who helped engineer this.

  11. Mr. Lansing, I think both libbies and Conservatives can agree and shake on the idea that Mr. Hickey is best serving humanity by staying where he gets the cheap haggis.

  12. Porter Lansing

    Mr. Hickey is quite tolerable compared to your friend Mr. Sibby.

  13. My latest to the RCJ. – –
    They probably won’t publish it !

    So, now our dynamic duo of senators are preparing to take their seats on the republican death panel (along with congresscritter Kristi who’s already joined) and vote “YES” for their “Better Care Reconciliation Act.”
    Don’t bother writing and/or calling these “representatives,” their votes have already been accounted and paid for. Should you waste your time doing this, you’ll receive a boilerplate, talking-points response (probably done by some anonymous staffer).
    Nobel laureate, economist Paul Krugman has written a handy guide to let you know if the bill is good for you. You’ll be happy, if:
    “1.Your income is more than $200,000 a year
    2.You have a job that comes with good health insurance
    3.You can’t imagine any circumstances under which you lose that job or income
    4.You don’t have any family members or friends who don’t meet those criteria
    5.You have zero empathy for anyone else.”

    The basic question on this, and so many others is in the title of the song from 1931: “Which Side Are You On?”
    What’s your answer?

  14. W R Old Guy

    Do not count on the courts to send you to prison if you commit a crime. A case out of the Kansas City area last week proved that judges can mess up the best plans although this case had nothing to do with health care.

    Last fall a 71 year old man had an argument with his wife and he told her “I would be happier in a prison cell than living in the same house with you”. He then robbed a local bank, and waited for the PD to show up. He confessed to the crime. He was sentenced last week to 50 hours of community service and 6 months home confinement!

  15. That 6 months of home confinement was the feller’s life imprisonment. I’ll bet he was head shy of the rolling pin for those months as well.

  16. mike from iowa

    CBO sez 22 million people lose healthcare by 2026 under Drumpf don’t care, thousands more unintended pregnancies if PP funds are cut and policies will double or triple in price.

  17. mfi, The CBO reading was not exactly complete. When the new bill comes out, we shall see them score it at around 26 million. Thune gets a nice bump in pay, Rounds gets a huge tickle and NOem thinks she is gonna be the queen, but no soup for her. Jackley slaps himself on the back for carrying the water for Daugaard and the rest of the ________. Can’tell Krebs, she is practicing her smile while lying.

    Gramps and Grandma have already had a diet of rice and beans in the past so what is coming for them is going to be much the same but without a sound roof to keep the moisture out.

    Maybe with Billie Sutton running, he can make the voice to people to wake the hell up to see what is going to happen immediately with the climax in 2026. A steady flow of removal from all safety nets until the last one is removed from the rolls. A country that takes care of its elderly, sick, along with women and children are what you call European country’s and our neighbors to the north and south. Here, we are just an average oligarchy much like our idol, Russia.

  18. John, I more than understand your sentiment, believe me, but it will greatly affect all of us who DID NOT vote for this bovine end product cluster bleep.