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The Baucus Bill: Public Programs

This section of the bill is actually pretty cheering. Medicaid now has a floor at 133 percent of poverty for all adults, with the federal government paying the lion's share of the expansion. The Children's Health Insurance Program (CHIP) now has a floor of 250 percent of poverty for all children. There's a lot of good stuff in this section, including a provision that allows hospitals to presume eligibility for Medicaid. But I think if I go much more granular here, I'll bore you all to death. Medicaid and CHIP changes are detailed on pages 41 to 61 if you're interested.

By Ezra Klein  |  September 16, 2009; 5:38 PM ET
Categories:  Health Reform  
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Comments

"This section of the bill is actually pretty cheering. Medicaid now has a floor at 133 percent of poverty for all adults"

Great now my State taxes will increase to pay for health insurance for deadbeat 30 somethings living in their widowed mothers basement.

Posted by: cautious | September 16, 2009 6:42 PM | Report abuse

firstoff, cautious, get your mind out of the basement and the penny-wise, pound-foolish nonsense.

The complaint-of-the-month about public heath options from the insurance industry, is "cost transfer" or "cost shifting." So the argument goes, Medicare and Medicaid have bigger groups and can contract for lower payment schedules. With Medicaid, they may have a point, but many doctors won't take Medicaid (don't know about all hospitals.)

However, Medicare (much bigger than medicaid, who's enrollees are younger and healthier) gets gouged too, in the form of overcharging. We call that "fraud and waste" but it is all too common, so common in fact, the feds have to turn a blind eye.

The bigger fish here is also that Medicare takes a huge burden off the actuary/premium pressure of insurance companies. The elderly and disabled that qualify for Medicare are the most expensive, highest risk group in the country. If insurance companies had to cover their claims, they'd be going bankrupt already (or facing a gray panther revolution), never mind the fantasy of the infamous "government takeover"

Add that to the fact that private insurer deny many claims on technicalities (cost-shifting bankruptcy tax deduction losses to the public sector) and let us not forget that individuals without insurance get charged twice as much for a hospital stay - that's "royal" cost shifting.

What Congress can do is come up with is, have the experts devise a uniform pay schedule for hospital procedure (that industry will chime in on) with very little wiggle room for exceptions. All payers, public or private must pay the same. Fee can be listed at the intake like a deli menu.

Burn one rib, and hold the ketchup.

Posted by: owldog | September 16, 2009 8:41 PM | Report abuse

YAY MORE ENTITLEMENTS!!!

PASS THE CHEETOS.

Posted by: visionbrkr | September 16, 2009 9:48 PM | Report abuse

@owldog: I believe that's something like the system in Japan. The complaint has been that fees don't keep up with provider's costs. But don't worry hell will freeze over before such a thing is implemented in the U.S.

@Ezra: I'm confused at how presumed eligibility for Medicaid is different than emergency Medicaid, which we have already.

Posted by: bmull | September 17, 2009 7:49 AM | Report abuse

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