Tag Archives: Nevada Medicaid

Incentives? What’s good for Geese and Ganders: Medicaid Work Requirements

We can rest assured the Nevada Policy Research Institute (aka Koch Bros) will be staunchly defending the notion that poor or working Nevadans are so debauched that any form of financial support will cause them to head for the couch and the TV remote, witness their position on work requirements for Medicaid recipients:

“Medicaid is supposed to provide a safety net for those who are unable to help themselves — an admirable goal,” said NPRI policy analyst Daniel Honchariw. “Unfortunately, as the system currently works, it actually encourages many able-bodied adults to stay out of the workforce. As a result, the program isn’t just draining public finances, it’s eroding the self-sufficiency of those it’s purportedly supposed to be trying to help.”  [h/t Nevada Independent]

Dear Lord, I’d hate draining away anyone’s “self sufficiency.”  However, I’m not prone to illusions about innumerable people who for reasons beyond comprehension prefer “getting welfare” to having a job.  But Wait!  Nationally, 42% of those non-SSI, non-elderly with Medicaid health insurance are working full time, another 18% are working at part time jobs.  14% are not working because they are ill or disabled.  12% are caregivers for someone who is ill or disabled.  6% of the enrollees are in school, and 7% give other reasons for not being able to work. [KFF] So, let’s be rid of the Medicaid as Welfare motif — it’s not welfare, it’s a health insurance program.  Further, 60% of the recipients are working full or part time.  So, what are the income requirements for Nevadans in the Medicaid insurance program?

“In addition to the basic Medicaid requirements, petitioners must qualify by earnings. What are the income requirements for Medicaid in Nevada? Nevada Medicaid eligibility requirements pertaining to income are structured around the federal poverty level (FPL). This financial marker of determining Medicaid benefits eligibility considers the size of the family and larger households will have higher income limits. Medicaid can provide health care coverage to households with income up to 138 percent of the FPL. However, children younger than 19 years of age with incomes up to 205 percent of the FPL will also be eligible for medical coverage.” (emphasis added)

Now we come to the Income Trap phase of the argument.  We can’t, dare not, increase the minimum wage from a paltry $7.25 per hour, argue the Conservatives, because to do so would “cost jobs.”  However, if one takes out the plastic brains, punches in the numbers for a person working 40 hours per week at a minimum wage job the conclusion displayed in the little calculator window will be below the 138% FPL line.  Here’s a thought: If the Republicans are bent on removing working people from the Medicaid rolls, how about raising the minimum wage to a living wage?  And, now we continue on to the Geese and Gander finale.

We’ve just survived the enaction of the Republican Tax Cut, Tax-Scam, in which it was argued that if middle and working class Americans would shoulder the burden of supporting the federal government and allow the corporations and hedge fund managers to “keep more of their hard earned money,” then our prosperity will soar, the economy will boom and those hard-working wealth management titans will work even harder at their investment strategies.  So, pay them more and they will work harder, and make their money work harder.  Funny, this principle never seems to apply to working people who drive trucks, serve food, repair fuel injection systems, build houses, landscape properties, clean hotel rooms, sell merchandise, type memos, file records, stock shelves,… you get the idea.

Thus, what is sauce for the Geese (those hard working wealth management, upper 1% of the income earners, etc.) i.e. more benefits and breaks from the government is toxic bilge water for the other 99% Ganders, who if given even the least disincentive in the form of affordable health care will shed their uniforms and work clothes, head for the nearest couch and dissipate into a mere shadow of their former selves as their “self sufficiency” is drained by the system.

Perhaps we should call this out for what it is — yet another attempt to reduce the number of people eligible for assistance with their health care expenses because rich people don’t want to pay for it.  Because they imagine some otherwise healthy soul taking advantage of their fellows merely because the are “unworthy.”  If this sounds selfish, it’s because it is, essentially, a fundamentally selfish argument.  The saddest part of the entire issue is that the Geese having quacked for years about Welfare Queens (non-existent) and Unworthy Lazy Bums have convinced numerous Ganders of the horrors of expending any funds in support of those less fortunate.   There is one last point illustrative of the moral deficiency of the conservative argument.

Opioids.  Remember those 7% who gave other reasons for not working?  Some of them have been laid off from jobs and are seeking new employment, and some others are finding it difficult to secure employment because of opioid addiction.  Just for the record, Medicaid covers about 4 in 10 non-elderly adults with opioid addiction.  13.9% are white non-Hispanic; 6.6% are Black, and another 4.6% are Hispanic.  13.7% are males, 7.3% are females.  [KFF]  If we want to address opioid addiction in this country then we need to be taking care of those who are seeking help with this scourge, and not lecturing them about the wonders of the free market system and healthy lifestyles.

We could use a few less lectures on the Great American Rugged Individual and a few more mentions of our collective responsibility to care for our fellow citizens as we would wish to be cared for by them.

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Filed under health insurance, Medicaid, Politics

What Nevada Loses under Trump-Doesn’t-Care

Here’s what Nevada loses under the egregious Trumpcare Bill:

(1)  138,100 citizens in Nevada will lose their health insurance coverage.

(2) 81,000 Nevadans will lose their Medicaid coverage.

(3) 439,000 Nevadans with pre-existing conditions will be put at risk.

(4) The bill cuts funding for care for 125,056 Nevadans with disabilities.

(5) It would raise the average health insurance premium for Nevadans by $677 in 2018.

(6) $288 million in new costs will be added to Nevadans in order to keep their Medicaid expansion.

Not a very good deal for the Silver State!

Call. Call. Call Senator Dean Heller.  702-388-6605    775-686-5770    202-224-6244

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Filed under health, health insurance, Heller, Medicaid, nevada health, Nevada politics, Politics

There they go again! GOP assault on Medicaid

It’s no secret the Republicans in Congress want to slash the social safety net. It’s also no secret Medicaid has been one of the favored targets for years.  The not-so-new-idea of late is to fund the program based on block grants.  There are some strong arguments against this:

(1) Block grant funding is set. Should a state have program costs exceeding the block grant funding one of two options are available – either appropriate state funds to make up the difference, or cut back on services or eligibility.

(2) The traditional match rate has been 50%, meaning that the state is insulated to some extent from unexpected cost increases and thus can ensure health insurance coverage for low income residents.

(3) When baffled by actual numbers, Republicans often return to the high-flying rhetoric about making the program more “flexible” under state control.  No. In reality the states already have that “flexibility” in terms of services covered, ways providers are paid for those services, the delivery of services, and eligibility levels.  [FUSA pdf]

Those who could see their health care access cut if Medicaid becomes a block grant program are those in Nevada who are earning $16,105 per year for an individual, or $32,913 for a family of four. (2014)  The ACA expansion of Medicaid allowed the state to add approximately 187,100 low income workers to the benefits.  Repeal of the ACA would obviously jeopardize this expansion, and cost the state approximately $1 billion in federal funds. [KFF and FUSAorg]

Consider for a moment that about 160,700 people in Nevada are employed in “accommodation and food services” jobs in which the average (mean) wages are $25,360 per year, the 10th percentile wages are approximately $16,450.   Or, we could look at health care support services with 18,860 employed at average (mean) wages of $33,900 with $22,470 at the 10th percentile and $26,500 at the 25th percentile.  [DETR]  Not to put too fine a point to it, but slashing Medicaid in Nevada would quite possibly have a negative effect on the ability of those employed in “accommodation and food services” to access health care, and these are the people who  work in one of Nevada’s major industries.  Home health care personnel wouldn’t fare much better.

When all else fails the Republicans haul out the “bankrupt system” allegations.  To the contrary, the Medicaid expansion has been a definite benefit to Nevada and other states:

    • CBO estimates show that the federal government will bear nearly 93 percent of the costs of the Medicaid expansion over its first nine years (2014-2022).  The federal government will pick up 100 percent of the cost of covering people made newly eligible for Medicaid for the first three years (2014-2016) and no less than 90 percent on a permanent basis.
    • The additional cost to the states represents a 2.8 percent increase in what they would have spent on Medicaid from 2014 to 2022 in the absence of health reform, the CBO estimates indicate.
    • This 2.8 percent figure significantly overstates the net impact on state budgets because it does not reflect the savings that state and local governments will realize in other health care spending for the uninsured.  The Urban Institute has estimated that overall state savings in these areas will total between $26 and $52 billion from 2014 through 2019.  The Lewin Group estimates state and local government savings of $101 billion in uncompensated care.  [CBPP]

A further note about uncompensated care, we need to look at the example of Pennsylvania and its latest report on the impact of expanded Medicaid and the Affordable Care Act:

“For the first time in a decade, Pennsylvania’s 170 general acute care hospitals in 2015 saw a drop in charity care spending, saving the average hospital about $200,000 over 2014, according to state data obtained by the Pittsburgh Post-Gazette.

Coupled with a nearly $300,000 drop in bad debt at the typical hospital, hospitals saved about $500,000 on uncompensated care in 2015, according to data from the Pennsylvania Health Care Cost Containment Council.

The state hospital association and patient advocates alike believe the drop in spending on charity care and bad debt is due to the impact of the Affordable Care Act, which is what experts said they believed caused a similar drop for the 24 states that adopted the ACA in 2014, as reported in the Post-Gazette series, Counting Charity Care, last year.”  [PPG]

Thus, in their ardor to repeal the Affordable Care Act and slash Medicaid support by turning the program into a block grant disaster, Representative Amodei (R-NV2) and Senator Dean Heller (R-NV) may need to explain:

(1) Why reducing support for a program which serves the least well remunerated among us – especially in one of our major industries – is a bright shining idea?

(2) Why eliminating programs which reduce uncompensated care costs to local hospitals and health care providers is also such a great notion?

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Filed under Amodei, Health Care, health insurance, Heller, Medicaid, nevada health

The Republican Unicorn: The Replacement Plan

UnicornOH! the horror… more Nevadans are now getting health care insurance thanks to the Affordable Care Act.  The Reno Gazette Journal reports:

“Nevada Medicaid enrollments under federal health care reform have surpassed initial projections and are on pace to reach 500,000 by summer, a mark initially not expected to be reached until the end of the 2015 fiscal year, a state official said.”

Prior to the enactment of the Affordable Care Act there were approximately 642,000 Nevadans without health insurance.  The expansion of Medicaid allows those who are earning  below 138% of federal policy guidelines to sign up for Medicaid.

For two person family the members of which are U.S. citizens between the ages of 19 and 65, who are not eligible for Medicare, the income line would be $21,404 per year, the income eligibility level for a single individual would be $15,856. [ME2014 pdf] A person working for $7.50/hr for a 50 week year would earn $15,000.

Since this is an election year, the Republicans will no doubt tell us all that they have an alternative, and indeed they did craft one earlier this year.

A side by side comparison of the Affordable Care Act and the Republican alternative:

ACA and GOP health plansIn the Republican “alternative du jour” people who don’t get health care insurance from their employers would end up paying more because in the GOP proposal the tax credit increases only by age and not by need.  This means that lower income individuals would be paying more for health care insurance.  [See example here]

Would those who have endured some of the questionable practices of insurance administration be protected under the Republican alternative?  Not really.  Under the Affordable Care Act an insurance corporation may only charge a 64 year old person 3 times what they would charge a 21 year old. Under the provisions of the Republican alternative they could charge 5 times more.

Then there’s the issue of a “coverage gap.”  If a person were to lose a job the compensation for which included health care insurance, the subsequent “gap” in coverage would allow the corporation to exclude the person from coverage because of a pre-existing medical condition if the individual did not purchase a private plan immediately.

In sum, the Republican alternative isn’t really “patient centered” a better term might be insurance corporation centered:

“There are many other problematic things the Republican plan does, like eliminate the health law’s taxes on health insurance, drug and device companies; allow insurance companies to sell plans that don’t cover maternity, mental health or other types of care; and allow insurance companies to impose annual limits on benefits.” [NYT]

Before we get too excited about the Republicans actually offering up an alternative to the Affordable Care Act and Patients’ Bill of Rights, we should remember that 2014 is an election year.  A person could waste precious moments in this life counting the number of Republican “working groups” which have developed GOP health insurance reform plans.  However, that exercise would expend synaptic effort unnecessarily because the GOP has yet to form any viable legislative strategy for enacting their ‘reforms.’

Harken back to January 30, 2014 — House Majority Leader Eric Cantor (R-VA) announced to the GOP conclave that “This year, we will rally around an alternative to ObamaCare and pass it on the floor of the House,” Cantor said during a presentation in which he outlined four areas — healthcare, jobs, helping the middle class and creating opportunities — where Republicans would offer “big, bold ideas.” [The Hill]   Now, hold this thought, because something happened to those “big, bold ideas” between January and March.

No sooner did the House Majority Leader pronounce, “This year, we will rally around an alternative to Obamacare and pass it on the floor of the House..” then the silent fog of actual inactivity enveloped the House Republicans.  By February 21, 2014 those big, bold ideas apparently disintegrated into a host of piece-meal bits of proposed legislation: “In a memo to members laying out the House agenda for the remainder of the winter, Cantor noted that the replacement is being finalized, and said that in the meantime, Republicans will work to target parts of the law with which they disagree.” [Roll Call]  Repeal and Replace, appears to be getting fuzzier by the month, a point not lost on columnist Jonathan Chait:

“Carping from the sidelines is a great strategy for Republicans because status quo bias is extremely powerful. It lets them highlight the downside of every trade-off without owning any downside of their own. They can vaguely promise to solve any problem with the status quo ante without exposing themselves to the risk any real reform entails. Republicans can exploit the disruption of the transition to Obamacare unencumbered by the reality that their own plans are even more disruptive.”

Meanwhile, more people are finding affordable private health care plans on the state and national insurance exchanges and more lower income citizens are signing up for the expanded Medicaid program.  And, the calendar marches on:
House Calendar 2014

And so, what has the House been working on?  On January 9 and 10, 2014 the GOP toyed with some headline generating legislation (H.R. 2279) delaying the implementation of the ACA and calling for ‘transparency.’   On January 23rd they launched on the ‘security’ of the health care exchange. (H.R. 3362).  Then they were back to the Ban The Abortion theme in the consideration of H.R. 7 on January 28, 2014, as if the Hyde Amendment has somehow been misplaced.

Do we see all that legislation to Repeal and Replace so avidly promised in January and then all but forgotten by March?  The Health and Technology Committee didn’t even meet during the month. [docs.house]

The lovely thing about a Unicorn is that it can be any color which delights a person’s imagination.  The same can be said of the Republican alternative to the Affordable Care Act — it can contain just about anything the audience wants to hear, because “facts are still being gathered,” or “provisions are still being drafted,” or “committees are still giving it consideration,” or “the dog ate my homework.”

Until the Republicans unveil their comprehensive alternative to the Affordable Care Act the Repeal and Replace slogan is just that — sloganeering.  And until the Republicans can demonstrate their capacity to LEGISLATE (read govern) there is no reason to take their propositions seriously.  While we wait for the Republicans to chase their Unicorn, we can applaud the fact that more of our fellow citizens have health insurance coverage, and wonder what the Republican Party will be able to do for the next five years.

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Filed under Economy, Health Care, health insurance, Medicaid, Nevada politics, Politics

Playing Percentages With Grandma? Romney-Ryan Medicaid Budget Cuts in NV

The median annual household income in Nevada is $55,726. [Census]  The total population estimate for 2011 is 2,723,322 and of these approximately 12.5% are over 65 years of age.  Some simple arithmetic shows that about 340,415 Nevadans are over 65 years old.   So what?

The question is important because some of these individuals will need home care services to deal with infirmities, some will need assisted living to remain independent, and others will require institutional care, aka nursing facilities.

As we can see from the Kaiser Family Foundation graph above,  more Medicaid resources have been allocated for home and community based care since 1995.  Long term care, which prior to 1995 meant institutional care for the most part, is now 43% home/community based health care services.   The issue now becomes do we want to fund the Medicaid program at a level which will allow more low income  Nevada residents over the age of 65 to remain at home, or do we cut program services such that we cope with only the most medically fragile?

The family issue, for that household earning the $55,726 annually, is how to provide care for an elderly relative who requires medical assistance beyond the financial capacity of the family to provide but who doesn’t need institutional care?  There is no answer to this inquiry from the Romney/Ryan budget.

In fact, if as Senator Heller and some of his colleagues recommend,  we repeal the Affordable Care Act (Obamacare) and do what the Republican ticket suggests — transform the Medicaid program into a block grant scheme — we cut approximately 38% from Medicaid services. [KFF pdf]  If we drill down into state by state statistics, if Obamacare were repealed and the Ryan Budget was adopted our Medicaid program in Nevada stands to lose about 44% of its funding. [KFF pdf]

No one would (or should) be so callous as to suggest we slash funding for those with the most serious medical needs, especially those who need nursing facility care.  However, if we’re looking down the line at a 44% reduction in Medicaid funding for state services then the obvious cuts would come “at the margins.”

Who’s marginal?  Are low income single mothers with two dependent children under the age of 6 marginal?  Are low income elderly persons who can still function — albeit barely —  independently marginal?

The Medicaid program in Nevada* is an insurance program which pays servicers to perform some or all of the following tasks:

-Adult Day Care
-Assistance Shopping for Essentials
-Caregiver Respite
-Case Management
-Companion Care
-Homemaker
-Housekeeping
-Laundry
-Meal Preparation
-Personal Care
-Personal Emergency Response System (PERS)

* In order to qualify for the Nevada Home and Community Based Waiver as of 2012, the applicant’s monthly income must be less than $2,094.  Their countable assets must be valued at less than $2,000.

Now, how many families can afford privately financed adult day care, companion care, housekeeping help, meal preparation, personal care, and shopping assistance? On $55,726 a year?  On an income of approximately $2,000 per month?

The obvious conclusion is that perhaps the Republicans are advocating for Crowded Housing?  If they bemoan the fact that recent college graduates are staying home with parents in a tight economy, think how much more familial the entire living situation becomes when the grandparents — or Uncle Festus or Aunt Minerva — move in?  Especially when the elderly relatives are simply in need of the kinds of home or community based services likely to be declared marginal in cost cutting binges?

While this might all sound a little facetious, the fact is that most houses in the U.S. ( some 67%) have two or three bedrooms. [Census] Every parent’s dream for when the offspring depart, be it the new guest room, the man cave, the sewing room — whatever — fails when a no long total independent older relative needs a safe place to live.

A modicum of concern for middle income families who are struggling to maintain their standard of living might be in order.   If we can assist middle income families with the costs associated with the care of a low income elderly relative; if we can chip in a bit so that a low income  elderly person can remain independent as long as possible — then why is is necessary to cut 44% of the Medicaid program in Nevada so that millionaires and billionaires won’t have to revert to paying the income taxes they were paying back in the Clinton years —  39.6%.  (They are current paying 35%.   All this for 4.6%. )

Let’s guess that the hedge fund managers and Wall Street wizards won’t be decimated by a 4.6% tax increase, but a 44% reduction in Medicaid funding in Nevada will have a profound effect on the other 99.99%.

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Filed under 2012 election, Health Care, health insurance, Heck, Heller, income tax, Medicaid, Nevada economy, Nevada politics, Romney, Taxation

Republican YOYO Home Economics: Medicaid Slashed, Other Support Burned

Former President Clinton advised the delegates to the 2012 Democratic Convention to listen carefully to what the Republicans were offering in regard to Medicaid, and those of us in Nevada should be “listening with both ears.”  Here’s the description of the Medicaid program as stated by the Nevada Department of Health and Human Services, the program:

“Provides health care coverage for many people including low income families with children whose family income is at or below 133% percent of poverty, Supplemental Security Income (SSI) recipients, certain Medicare beneficiaries, and recipients of adoption assistance, foster care and some children aging out of foster care. The DHCFP also operates five Home or Community-Based Services waivers offered to certain persons throughout the state. The Division of Welfare and Supportive Services (DWSS) determines eligibility for the Medicaid program.”

Listing those categories focuses on the aims of the program — it is to serve (1) low income families with children; (2) elderly Nevadans; (3) low income Nevadans over 65 years of age; (4) families receiving assistance for adopted children; (5) children in foster care.  Who was enrolled in Nevada’s Medicaid program as of fiscal year 2009:

What services were provided to those enrolled in Nevada’s Medicaid program?

During fiscal year 2010, 68.1% of the spending from the Medicaid program went for acute care, 25.6% was allocated for long term care, and 6.3% was used for “disproportionate care – hospital payments.”

The spending for long term care breaks down as illustrated in the following chart:

11.1% of the long term care funding was allocated to facilities for the intellectually disabled, 2.9% went to services for the mentally ill — and notice — 86% was used to provide home health & personal care, and nursing facility care.  In other words, 86% of Nevada’s Medicaid expenses for long term care went toward serving those least able to care for themselves.  The other 14% was used to provide intermediate and long term care for those unable to care for themselves because of intellectual limits or mental illness.

Here is exactly why President Clinton told his audience to “listen up:”

My view is get the federal government out of Medicaid, get it out of health care. Return it to the states.” – Romney, South Carolina GOP Primary Debate, Jan. 20, 2012.

In case anyone is remotely confused about what that statement from the former Massachusetts Governor means, he’s speaking about transforming the Medicaid program into Block Grants.

More specifically, the former Governor is adopting the block grant proposal for Medicaid set forth in his running mate’s “Path to Prosperity” budget plan:

“The plan also would repeal health system reform law provisions that will expand Medicaid coverage starting in 2014. Instead, states would receive block grants, which would free states “to tailor their Medicaid programs to the unique needs of their own populations,” the budget says.”  [AMA]

The tailoring is to be done with less cloth:

The Ryan budget would cut $2.4 trillion from Medicaid and other health programs. Reduced spending would increase the number of uninsured dramatically, Park* said. “Those who retain coverage will have benefits scaled back and have higher cost-sharing.” [AMA] (emphasis added)

We can drill down further into what Governor Romney and Representative Ryan have in mind for the Medicaid program by looking at the Congressional Budget Office’s analysis of the Ryan position:  Medicaid and the Children’s Health Insurance Program (CHIP)—from 2 percent of GDP in 2011 to 1¼ percent in 2030 and 1 percent in 2050.

Now is the moment to recall that 58% of those who receive Medicaid assistance for their health care needs in Nevada are children, and the AAP isn’t thrilled at cuts to that constituency:

“American Academy of Pediatrics President Robert W. Block, MD, said the proposal would undo investments in health programs for children. More than half of Medicaid recipients are children, but their care accounts for up to only one-quarter of the program’s costs.

“Whether considering fiscal year 2013 federal spending bills or reviewing long-term budget proposals, Congress must seize this opportunity to invest in the future of our country by protecting children’s health,” Dr. Block said.” [AMA]

Dr. Block has reason to be concerned, if we return to the Congressional Budget Office’s analysis we can see why.  In two paragraphs from their analysis of the Ryan “Path” the non-partisan office explains why the proposal would make deep cuts, and place greater burdens on the states:

“The specified path (Ryan Plan) would cause federal spending on Medicaid and CHIP to decline relative to GDP in coming decades, rather than to rise sharply as in the other policy scenarios that CBO has analyzed, and would include no exchange subsidies (see Figure 3). As a result, by 2050, such spending would be 76 percent below what would occur for Medicaid, CHIP, and exchange subsidies under the baseline scenario and 78 percent below what would occur under the alternative fiscal scenario. Because spending on CHIP and exchange subsidies represents a relatively small share of the amounts in the baseline and alternative fiscal scenarios, most of the reduction would have to come from the Medicaid program.” [CBO] (emphasis added)

The Republicans do, indeed seem serious about eliminating Medicaid as a federal program and shifting the expenses for health care access to low income elderly, the disabled, the intellectually disabled, elders in nursing facilities, and children in poverty to the states.  The CBO explains the nature of this shift:

The responses of the states would be of particular importance. If states were given additional flexibility to allocate federal funds for Medicaid and CHIP according to their own priorities, they might be able to improve the efficiency of those programs in delivering health care to low-income populations. Nevertheless, even with significant efficiency gains, the magnitude of the reduction in spending relative to such spending in the other scenarios means that states would need to increase their spending on these programs, make considerable cutbacks in them, or both. Cutbacks might involve reduced eligibility for Medicaid and CHIP, coverage of fewer services, lower payments to providers, or increased cost-sharing by beneficiaries—all of which would reduce access to care. (emphasis added)

Translation: Even if the states were able to achieve all the vaunted efficiencies a “flexible” plan might provide — the cuts proposed are so deep and so drastic that citizens in the United States who are lower income elderly or the disabled in nursing homes, and those who are low income and living in foster care, or families in poverty — would have reduced access to care. Period.

These aren’t generic numbers and pie in the sky statistics we’re talking about, we’re speaking of 25,841 elderly Nevadans, 40,898 disabled Nevadans, 55,626 adult Nevadans – mostly women, and 168,070 Nevada children.

So, here’s a question for Governor Romney and Representative Ryan — If no matter how much efficiency the state of Nevada squeezes from your block grants for Medicaid, Nevada and the other states will still have to either appropriate significantly more revenue, or drastically reduce services — how is your plan anything other than a proposal to shift the burden of health care costs, for the least able among us, from the federal treasury to the state treasuries and the pockets of low income Americans?

Where, Governor Romney and Representative Ryan, does the Nevada Legislature start cutting? From the acute care services for adopted or foster children? From the acute care for pregnant women? From acute care for children in poverty who have asthma, autism, broken arms, or sprained ligaments?  From the long term care for the elderly who need home health care services and personal care to avoid institutional living?  From the long term care for the indigent mentally ill?  From elderly residents of nursing facilities?  From disabled children who need home health care? Where?

Perhaps cuts aren’t the only option. Must the Nevada government raise the eligibility standards such that only those living at “25%” of the official federal poverty level can receive assistance?  Here are the 2012 guidelines from the Department of Health and Human Services —

How much more should a family of four living on $1,920.83 per month  have to pay for basic health care?  How much more should a young man and his pregnant wife living on $1,260.83 per month have to pay for pre-natal care, and expenses associated with the birth of their first child?  For a political party which lauds its “Pro-Life” stance — asking low income families to dig deeper to pay for health care to make up for federal and state budget issues (while proposing more tax cuts for the top 1% of American income earners), makes it sound as though the GOP is the Pro-Birth, not Pro-Life party.

How much more should a young family have to pay for health care before the cost of health care begins to impinge on the capacity to put a roof over their heads?

Or their ability to put food on the table?  It’s likely going to cost our young family with two children under the ages of 19 approximately $366.40 to $578.40 per month to keep everyone fed. [USDA] Our hypothetical family might be lucky to have $764.43 per month remaining after housing and food for utilities, clothing, transportation costs (auto payments or bus fare) — that $764.43 translates to about $25.48 per day to cover ALL the basic family needs listed previously… including Health Care.  But wait, the Romney/Ryan budget cuts nutrition assistance too, drawing fire from the U.S. Conference of Catholic Bishops:

“Cuts to nutrition programs such as the Supplemental Nutrition Assistance Program (SNAP) will hurt hungry children, poor families, vulnerable seniors and workers who cannot find employment. These cuts are unjustified and wrong.” [The Hill]

And what other program do the Republicans fantasize about turning into a Block Grant Program and then cutting?  Housing subsidies. [TO.org]  There was some discussion of the Ryan proposal on this topic at the March 21, 2012 House Budget Committee hearing:

“Rep. David Price (D-NC) asked Donovan what the implication of the Ryan budget cuts would be on HUD programs such as public housing, Choice Neighborhoods, HOME and others.  Donovan responded that, under the proposed Ryan budget, approximately one million households could lose their housing.  Of the one million households at risk under the Ryan budget, Donovan estimated that 585 thousand would come from the Housing Choice Voucher Program, 425 thousand from the Project-Based Voucher Program, and 110-180 thousand from homeless assistance programs.  He also mentioned that an estimated 17 thousand jobs would be lost from CDBG, and cuts to the HOME program would mean tens of thousands of new affordable housing units would not be built.”  [CLPHA] (emphasis added)

So, no help for financially fragile families for health care, or housing, or food — or anything, but tax payers in the top 1% of all our income brackets will get more, yet more generous, tax breaks.  Little wonder the Bishops were annoyed.  Less wonder Sister Simone Campbell from Nuns on the Bus received a standing ovation at the Democratic National Convention.

A person doesn’t have to be Roman Catholic to find the Republican proposals supported by Governor Romney and created by Representative Ryan astonishing in their parsimony and appalling in their avarice.

Perhaps one has to be incited by the fact that a family in Las Vegas might have an air-conditioner, or a DVD player, or a functional motor vehicle — “Look,” cry the miserly, “They have nice stuff, and they got it by doing nothing.” Not. So. Fast.   As of 2010 not that many Nevadans were receiving public  assistance. [Census] In fact, about 3% of Nevadans were receiving public assistance. [Census pdf]

Thus much for the Miserly Myth that “They’re all sitting around collecting welfare, and learning to be dependent on Guv’mint.”  Perhaps we should add the usual follow up, “and they’re doing it on my hard earned tax dollars.”  The latter portion is correct, we do pay taxes which support assistance programs for fragile families.  However, the Grinches among us appear to believe they are the only ones chipping in.

S’cuse me Mr. Grinch, but I really don’t mind paying a fractional portion of my income to insure NO child goes to bed hungry, NO elderly person with dementia is left alone, NO foster child is left with an untreated case of pneumonia, NO pregnant woman is without pre-natal care, NO family is homeless, NO mentally ill person is abandoned, NO disabled child is without care.

This is what Democrats mean when we say, “Just Say No.”

References and Resources:  * Edwin Park, CBPP.  Congressional Budget Office, Ryan’s Specified Paths, March 2012. (pdf) “House Republican Budget Seeks to Slow Medicare, Slash Medicaid,” American Medical Association, April 2, 2012.   Kaiser Family Foundation, State Health Facts, Database.  “Public Assistance Relief,” Census, Department of Commerce, pdf.  “HUD Secretary Defends FY13 Budget Before House Appropriators,” CLHPA.   “Four Ways Romney and Ryan Would Roll Back the 20th Century ,” Jake Blumgart, AlterNet, September 5, 2012.  “What Paul Ryan’s Budget Actually Cuts,” Brad Plumer, Washington Post, August 12, 2012.  USDA, Cost of Food Plans, Center for Nutrition Policy and Promotion, May 2011 (pdf).  ASPE, Department of Health and Human Services, HHS Poverty Guidelines 2012. Congressional Budget Office, “The Long-Term Budgetary Impact of Paths for Federal Revenues and Spending Specified by Chairman Ryan,” March 2012, pdf.   Kaiser Family Foundation, link to interactive database for state health care statistics.

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Filed under 2012 election, Economy, family issues, Health Care, health insurance, Medicaid, Nevada budget, Nevada child welfare, nevada health, Nevada politics, Politics, public health, Republicans, Romney