Tag Archives: uninsured cost-shift

Medicaid Increases Emergency Room Use. Obamacare increases Medicaid dependence.

John R. Graham writes:

This result is important for anticipating the consequences of ObamaCare. About half of the 30-plus million people expected to get health insurance under ObamaCare will be enrolled in Medicaid, not private health insurance. Already, the Administration asserts that four million new Medicaid enrollees have signed up via ObamaCare (but this estimate has been questioned).

Nobody should be surprised: Despite politicians’ assertion that Medicaid coverage increases the likelihood of using primary care, rather than an ER, the evidence points clearly to the contrary. For example, in Massachusetts, ER use soared by 17 percent two years after Gov. Romney’s law mandating insurance coverage came into effect.

Read more: Least Surprising Health Research Result Ever

See also “Medicaid Expansion Drives up Visits to ER,” Wall Street Journal, January 2, 2014.

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Colorado Medicaid expansion: Denver Business Journal spreads myth of unsinsured cost-shift

In the Denver Business Journal, Ed Sealover describes the effect of Gov. Hickenlooper’s proposed Medicaid expansion on businesses:

The most direct effect of the move on general businesses could be a long-term slowing of the growth of health-insurance costs if hospitals can reduce the cost of uncompensated care for uninsured patients — which they now pass along to patients insured by employers by increasing their costs of care.

I left the following comment:

This analysis does not account for how much Medicaid, through low doctor payment rates, increases insurance premiums. This amount is much more than the amount uninsured people increase premiums when they do not pay part of all of their medical bills. For details on this, see my article: Your Health Care; Don’t Trust the Colorado Trust.

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Your health care: Don’t trust the Colorado Trust

Colorado TrustThis article originally appeared in the print edition of the Boulder Daily Camera on March 31, 2012.

The Colorado Trust is a statewide grant-making foundation with assets exceeding $400 million. It claims to be “dedicated to achieving access to health for all Coloradans.”  The Trust and its grantees use shifty arguments to support ObamaCare’s individual mandate, which requires Americans to purchase a politically-approved health plan. With the Supreme Court’s hearings on the mandate’s Constitutionality just completed, it’s time to reveal the flaws and deceptions behind the Trust’s advocacy.

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San Luis Valley Regional Medical Center spreads flawed justifications for mandatory insurance

Gena Akers of the San Luis Valley Regional Medical Center writes that requiring people to buy politician-approved health plan “works” because “free-riders are not allowed, therefore no cost-shifting.” This common justification for mandatory insurance (a.k.a., the individual mandate) is dubious at best and misleading at worst.

As I’ve written before:

In Colorado, the cost-shift from the uninsured is just $85 per insured person. This is according to research done for Colorado’s 208 Commission. …

Key findings include that “the uninsured pay for about half of their care out-of-pocket” while only “20 percent is uncompensated care from providers.” An Urban Institute study provides further evidence that uninsured cost-shifting is small — at most “only 1.7% of private insurance premiums.”

By outlawing affordable plans, mandatory insurance increases premiums by much more. Consider the federal health control bill, HR 3590. It requires that all plans include at least ten mandated benefits, such as maternity care and substance abuse treatment [HR 3590, sec. 1302], whether you want them or not. A typical mandated benefit increases premiums by about 0.75%, concludes a 2008 MIT study.

Oddly, many proponents of mandatory insurance support Medicaid and Medicare, even though they impose large cost shifts — even when not counting the taxes the insured pay to fund these programs. As I’ve written elsewhere:

A Milliman actuarial study concluded that the cost-shift from Medicaid and Medicare adds $1788 to the annual insurance premium for a family of four. The uninsured pay more of their medical bills than Medicaid does for its participants, reported Reuters in 2008. What’s more, a CDC study found that people “with Medicaid coverage were more likely to have had multiple visits to [emergency departments] … than those with private insurance and the uninsured.”

Also, if the uninsured are free-riding, to my knowledge they can most easily do this in emergency departments because EMTALA forces doctors to treat them. But emergency treatment is a small fraction of total medical spending.  If supporters of mandatory health plans were sincerely concerned about this, they’d support only forcing everyone to buy a plan that covers only emergency room treatment, rather than bloated plans with mandated benefits that appeal to groups that lobby for them.

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Filed under Colorado health care, mandatory insurance

Colorado underestimates Medicaid cost, scales back program

Last week Tim Hoover of the Denver Post reported that:

Two years after lawmakers expanded Medicaid to cover poor adults without children, the state is vastly scaling back the program because the number of people eligible for coverage is nearly three times as high as first projected and the cost of insuring them is almost nine times original estimates.

Read the whole article: Colorado scaling back Medicaid after drastically underestimating numbers, cost.

On Monday of this week, the Post’s Editorial Board opined:

The larger takeaways are that the nation’s health care crisis may be much bigger than can be gleaned from the 30,000-foot level and that politicians could be in for sticker shock when federal health reform comes online beginning in 2014. …

[T]he situation should serve as a warning: Sizing up the nation’s health care ills is not an exact science, and addressing it could be costlier, and more complicated, than we envisioned.

Read the whole editorial: Sticker shock on health care. Thanks to CompleteColorado.com for linking the editorial.

Should the post really be surprised? A couple of years ago the Wall Street Journal reviewed how government programs often exceed their spending estimates.  In May 2010 ABC News reported that the “Health Care Bill Will Cost $115 Billion More Than Previously Assessed.” It wouldn’t surprise me if there’s a more recent increased estimate.

The Post’s editorial also perpetuates the big lie of health care policy: “We all pay for treatment of this population now, but do it through the so-called “hidden tax” of providing them costly emergency and other services.” Read my refutation of this cost-shift fallacy.

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Hickenlooper’s veto of SB 11-213 insults low-income parents

The Boulder Daily Camera published my article criticizing Governor’s veto of Senate Bill 11-213. Here are the first and last paragraphs:

“Let them drink beer, while you pay.”  This is how Colorado taxpayers should interpret Governor Hickenlooper’s recent veto of Senate Bill 213.  For some families, SB 213 would have increased the Child Health Plan Plus (CHP+) enrollment fee to $20 per month. This is what the lowest income U.S. households spend on alcohol.

CHP+ officials will soon propose changes to CHP+ fees and possibly co-payments, which are also extremely low. Maintaining current fees would not only be an injustice to taxpayers, but also an insult to eligible parents. The fees imply that parents value enjoying life’s amenities more than their own children’s health.

Read the whole article in the Boulder Daily Camera.

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Mitt Romney, mandatory health insurance, & the phony free-rider justification

Jeff Jacoby makes a few excellent points in his recent Boston Globe article on Mitt Romney, mandatory insurance, and health care policy:

  • “To begin with, just because a 25-year-old law [EMTALA] requires hospitals to provide emergency care to all comers, why does it follow that another law must force every citizen to buy insurance?”
  • “[I]f the individual mandate’s purpose is to prevent free riders from shifting the cost of their emergency care to others, all it should require is enough insurance to cover a trip to the emergency room. Instead, both RomneyCare and ObamaCare require everyone to be covered for numerous benefits going far beyond emergency care.”Of course, mandatory insurance is not about “individual responsibility, but forcing you to buy more insurance than you need, which is in effect a tax to pay for other people’s health care. That’s socialized medicine.Jacoby continues:
  • “Supporters of the individual mandate often imply that going without insurance and being a free rider are one and the same. They aren’t.”  Four conditions must be met for an uninsured person to be a free-rider.
  • “[F]ive years of the RomneyCare mandate have done nothing to reduce the crowding in Massachusetts emergency rooms.”
  • “It is true that fewer Massachusetts residents are uninsured. But most of the newly insured aren’t paying their way: They’re being subsidized by taxpayers.”

Read more: Romney’s steadfast stand for a bad idea.

(via FIRM)

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