Press "Enter" to skip to content

Thune and Rounds Threaten Big Cost Shift to Counties with TrumpCare

I mentioned last month that our Congressional delegation’s drive to repeal the Affordable Care Act (and in this week’s vote-a-rama, Senators John Thune and Mike Rounds have remained in lockstep with TrumpCare) ignores the harsh impacts those health care cuts will have on county budgets.

My local paper substantiates this claim with a fiscal warning from Brown County:

Brown County Welfare Director Cliff Rhodes said losing the Affordable Care Act would mean the county would be faced with higher expenses for indigent claims.

“The deal is that under South Dakota law, in order for people to be eligible for hospitalization expenses through the county, one of the tests they have to meet is that they were unable to get insurance on their own,” Rhodes said. “If they were able to get insurance on their own, but they failed to do so, then they’re called indigent by design. If they’re indigent by design, they don’t quality for county assistance.”

Prior to the Affordable Care Act, Rhodes said, the county saw a lot of claims from people who couldn’t get coverage because they had pre-existing conditions. Now, he said, those folks qualify for insurance.

“So as a result, we denied a lot of the claims that we used to pay,” Rhodes said. “Depending on what happens with the repeal, if Obamacare is repealed, it will definitely have a big impact on the county budget” [Elisa Sand and Shannon Marvel, “GOP Vote Had No Effect on Health Coverage,” Aberdeen American News, 2017.07.27].

AAN had to bury that politically problematic statement at the end of the article, off the front page and out of the strangely momentary and diversionary headline. But Brown County’s explanation of where many of those millions (16 million under “skinny repeal“) of newly uninsured Americans will turn for coverage—local county services—should be on top of the stack of policy briefs Thune and Rounds should be reading this week.

Brown County voted for Trump over Clinton 59.7% to 33.8%. That Trump and his Senate lackeys would vote to bust our county health care budget is another example, just like Trump’s treatment of his lapdog Jeff Sessions, that Trump cares about no one but himself.

20 Comments

  1. mike from iowa 2017-07-27 10:56

    Rhodes said. “If they were able to get insurance on their own, but they failed to do so, then they’re called indigent by design. If they’re indigent by design, they don’t quality for county assistance.”

    Does this mean a poor person may have to spend every penny they earn on insurance and forego food and housing, etc? There seems to be a universe of information missing here.

  2. jerry 2017-07-27 10:57

    Once upon a time before ACA/Obamacare, if you were injured in the county by something like a car accident and you did not have insurance or the ability to purchase it, the county was stuck with the bill. Sometimes the bill was huge. So it looks like over lunch today, our two cult senators will both be voting for trumpcare. They do that with the full idea that trump cannot harm a state like ours by taking anything away. When ya got nothing, ya got nothing to loose.

    Alaska does though, see how a dictatorship works https://www.adn.com/politics/2017/07/26/trump-administration-signals-that-murkowskis-health-care-vote-could-have-energy-repercussions-for-alaska/

  3. o 2017-07-27 11:38

    This again brings us to the central question of this whole discussion, the central question that remains unanswered: is it OK that some people do not get health care because they cannot afford it? Is health care like a commodity like a big-screen TV: it is good to have it IF (and only IF) you can afford it?

    Because the discussion has layers and layers to dig through, the bad guys in the discussion are well covered. We discuss health INSURANCE, not health CARE directly. The insurers claim that the cost of insurance is being driven up by the cost of health care. For decades we have given a free pass to the care providers who drive up costs. Who is making the money from $30.00 aspirin, $40.00 ace bandages, $50.00 saline IV’s, or tens of thousands of dollars in price swings for the same surgeries in different facilities . . . Why does health care cost SO much in the US (and who profits from that)?

  4. Porter Lansing 2017-07-27 11:58

    @o … A lot of the extra cost (compared to other countries with better and cheaper healthcare) is from overhead expense from insurance sellers. That doesn’t happen with non-profit insurance.
    ~ I believe healthcare is a right for USA citizens and visitors, alike. I also believe there is a large group that want to have better insurance and better healthcare than people less successful than themselves.
    ~ How about a bare bones, safety net, Medicare plan for everyone … paid for with payroll deductions?
    ~ How about also allowing insurance companies to sell any plan they choose, for those that want better coverage?
    ~ It’s a combination of collective and private that should please anyone who’s more than just contrary to any changes.
    ~ Many countries follow this plan to a pretty high level of acceptance by their voters.

  5. jerry 2017-07-27 11:59

    o, regarding insurers, the provider contracts they hold with doctors and hospitals dictate that the bill submitted by them will be paid under the Current Procedural Terminology or CPT codes they are filed under. So, if your procedure shows on the CPT code to be paid at $150,000.00, then the provider of the service has the green light to collect that from the insurance company. Both the provider and the insurance company have systems in place to monitor those bills to try to eliminate error.

    If you take a look at Nexium as an example. If that drug is prescribed and you buy it from a pharmacy, you will pay upwards of $500.00 for a 30 day supply. Of course, people with insurance pay no attention to that dollar amount as they pay a copay of $10 bucks to $20 bucks for the prescription. If the consumer is smart, they would look to the over the counter Nexium for a 30 day supply and purchase it for $24.00 more or less. See the issue? The consumer says to hell with paying $24.00 for my over the counter when I can just get the prescription for $10-$20.00 and save enough for a burger and fries. The consumer does not look at the bill to see that the $500.00 is being paid by the insurance company and that price will have an effect on his premium through adverse claims. So the $10 bucks the consumer thinks they pulled a fast one on, comes back at insurance renewal time to bite them with an increase that is now $75.00 a month increase.

    So then, who profits? Everyone but the consumer. One has to ask themselves, why is Nexium so much different in price in 10 foot of floor space? How can there be $480.00 difference in price from walking the distance of a bass boat in the same store?

  6. Roger Cornelius 2017-07-27 12:19

    If Thune and Rounds held a town hall and explained to republican county commissioners and the general public of their plan to shift costs to the counties, how well do think that would go over?

    Hopefully hospitals and doctors in ER’s around the state are prepared for this expense and what will eventually turn out to having to write-off debt because the average citizen doesn’t have the money for insurance or to pay the monstrous costs of medical care on their own.

    Thune and Rounds just have to admit that they want to take us back to pre-Obamacare days.

  7. W R Old Guy 2017-07-27 13:51

    Rounds was on the SDPB morning show today. The host asked him about the effect on South Dakota under the Republican health care plan with the huge cuts to MEDICAID.

    His response was that giving the states the block grants with the freedom to tailor MEDICAID to the states needs would be an increase. He cited allowing the state to cut the MEDICAID expansion to 137% of the poverty level and require the “able bodied recipients” who refuse to work to get jobs.

    Are there any statistics on the number of “able bodied” MEDICAID recipients? I have not seen any. Will these recipients get MEDICAID if they get jobs but still qualify for MEDICAID?

    I only heard this small part of the program. I wonder if he was asked what happens when the MEDICAID expenses exceed the money in the block grant?

  8. Richard Schriever 2017-07-27 14:56

    o – the cost of health CARE is driven up due to the obligation – the LEGAL OBLIGATION – of health care providers to provide health care to EVERYONE – whether they can pay or not. So, health care PROVIDERS charge high rates to make u for care they are required by law to provide WITHOUT COMPENSATION. The cost of providing care to the uninsured thus falls to all the rest of us.

  9. Richard Schriever 2017-07-27 15:01

    Roger – the debts don’t get “written off” – they get “written in” to the costs of procedures.

  10. Roger Cornelius 2017-07-27 15:23

    Richard

    I suspect you are probably correct about passing along debt to procedural costs, but do you think hospitals and doctors will admit it?

  11. bearcreekbat 2017-07-27 15:30

    mfi raises a great question about Rhodes statement: “If they were able to get insurance on their own, but they failed to do so, then they’re called indigent by design. If they’re indigent by design, they don’t quality for county assistance.”

    SDCL ch 28-6 contains the statutory requirements for medical assistance to the indigent. I found no exception for someone deemed “indigent by design.” If Rhodes’ county is denying anyone care because they are deemed “indigent by design,” the county is acting illegally under SD statutes.

    In addition, unless there has been some change in law, SD hospitals that comply with statutory filing requirements and treat an indigent have standing to sue any county for the cost of that care.

    http://law.justia.com/cases/south-dakota/supreme-court/1987/15412-1.html

  12. Richard Schriever 2017-07-27 15:31

    I think they are pretty up front about it- as are insurance companies. It is only the politicians that fail to speak to this issue.

  13. Douglas Wiken 2017-07-27 16:33

    Rounds just sees converting medicare and medicaid funds into block grants as another boondoggle for possible rip off like the EB-5 funds. Rounds is the pond scum of the Washington Swamp

  14. jerry 2017-07-27 16:37

    By tomorrow, it will not matter much as this thing plods on. The country is going to suffer an immense pain from this in all senses. Including the insurance industry and healthcare industry all. If I were running for national office, the first folks I would be talking to for campaign contributions would be them. https://www.ahip.org/wp-content/uploads/2017/07/AHIP-Letter-to-Leaders-McConnell-Schumer-7-27-2017.pdf

    Now onto the dismantling of Social Security itself, count on it. When you alter Medicaid, you are opening the door to the destruction of Social Security itself. Rounds can now get a bigger boat and Thune can finally purchase a real brain.

  15. Buckobear 2017-07-27 18:28

    If “they” are required to obtain insurance “if they can get it,” isnt’t that a MANDATE ???

  16. jerry 2017-07-27 18:32

    Good point Buckobear, that is exactly what a mandate is.

  17. Adam 2017-07-27 20:43

    Great post!

    Too bad though, rural people still seem prepared to pay up the nose to see thier idiot butt face hero talk like a jerk on camera. Trump’s tweets really make it worth their money.

    If elected officials from rural states really think their own constituents need to be more self reliant on health care – maybe they are right. After all, they are in deep intimate touch with their constituents, and maybe it’s just too expensive to spread health care services so thin – all over the middle of nowhere in America, while the population centers are so important in terms of GDP for this country.

    Maybe Thune, Noem and Rounds are right. Maybe Obama Care puts too much into caring for rural people, but I’d like to hear more from them, about it, before I start drawing conclusions.

  18. Loren 2017-07-27 21:51

    Mikey has been showing up on a lot of news interviews lately. Must be because he is like KellyAnne Conway, willing to go before the cameras and LIE HIS BUTT OFF! It’s embarrassing to watch him read Republican talking points, even when it is pointed out that facts do not agree with his statements! We are so proud…

Comments are closed.