Marc Kilmer
Marc Kilmer is a Maryland Public Policy Institute senior fellow specializing in health care issues. He began his career in public policy as a legislative assistant to U.S. Sen. Larry Craig (R-ID), where he worked on education, transportation, and housing issues as well as federal appropriations, public land policy, and gun rights.
After leaving Craig’s office, Kilmer served for three years as executive director/CEO of the American Congress of Community Supports and Employment Services, a Washington, D.C., trade association of nonprofits that provide services to people with disabilities.
Besides his work with MPPI, he also works with the Buckeye Institute for Public Policy Solutions, a free market think tank in Ohio.
Kilmer has a Bachelor of Arts in history and political science from Hillsdale College in Michigan and lives in Salisbury, Maryland, with his wife.
Thursday, July 2, 2009Maryland Medicaid Expansion Exceeds Cost EstimatesBy Marc KilmerCategories: Maryland, MedicaidLooks like Maryland's expanded Medicaid program is a little more popular than expected:
And who predicted as much back in 2007? Oh, that's right, I did:
Anyone who looked at Medicaid spending over the past decade would have had a hard time coming to a different conclusion. Unfortunately, our state legislators did just that and expanded Medicaid during a special session that was called to close a budget deficit. The irresponsibility boggles the mind.
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Wednesday, July 1, 2009Idaho Insurance Change Making Some State Workers UnhappyBy Marc KilmerCategories: Government employees, IdahoGovernor Butch Otter of Idaho has decreed that instead of part-time state employees receiving the same health insurance benefits as full-time employees, part-timers will have to contribute to their premiums based on the number of hours they work. Government workers are, as may be expected, upset. As this Idaho Statesman article points out, though, Governor Otter is simply moving the state in the same direction as the private sector and other state governments. Currently, the state offers a generous plan where an employee covering only himself pays $30 a month for a health insurance policy that has a total cost of $752. That's about 4%, which is a very good deal for state employees. Under the governor's plan, "the state is moving to a bracketed plan, where employees working 28 to 35.9 hours a week pay 20 percent of the cost of their premiums, and employees working 20 to 27.9 hours pay 40 percent of the premium." Considering the very low premiums full-time state workers pay, perhaps the governor should consider raising their rates, too. As the article points out, private sector employees in Idaho pay around 16% of their employees' premiums. There is no reason why state employees should pay 1/4 of that.
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Friday, June 26, 2009New Jersey Embraces Autism MandateBy Marc KilmerCategories: Insurance Regulation, New JerseyIt looks like New Jersey will become the 14th state to mandate insurance companies cover autism treatments. The legislature finalized work on an autism mandate bill yesterday and the governor is expected to sign it. Reading the news story, I was a little confused, to be honest. The way it was written ("New Jerseyans with autism and other developmental disabilities would get up to $36,000 in certain treatments covered each year, under a bill that cleared the Legislature today") sounded to my ears like legislators set up some state program to hand over money to families with autistic kids. This legislation, however, is not that honest. Legislators will receive kudos for helping autistic kids but they don't have to find the money to do it (an almost-impossible proposition given the New Jersey budget mess). Instead, legislators mandate that everyone pay more for insurance to help a few people gain access to expensive therapy that is of questionable efficacy. Don't you just love the policy process?
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Wednesday, June 17, 2009Ohio Governor Suggests Medicaid CutsBy Marc KilmerCategories: Medicaid, OhioOhio is facing a $2 billion deficit (even after trying to paper over its spending problems with billions in federal "stimulus" money). So it seems that Governor Ted Strickland, who came to office promising to expand Medicaid, is now looking to cut it:
I'm not sure the Passport cuts are all that cost-effective, since it will mean fewer people will receive less expensive in-home care and instead receive services at a more expensive institution, but in general the governor's on the right track. Of course, if he'd listened to me two years ago, maybe the state wouldn't have quite as large a fiscal mess:
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Monday, June 8, 2009Marylanders Favor More Govt. Intervention in Health CareSome chambers of commerce go along, too By Marc KilmerCategories: Insurance Regulation, Maryland, MedicaidThe results of a poll commissioned by the left-wing Maryland Citizens Health Initiative (MCHI) found that, not surprisingly, a majority of Marylanders want health care reform and they also support a plan to raise taxes for expanded Medicaid coverage. I say "not surprisingly" both because you wouldn't expect any group to release poll results that run counter to its agenda, but also because it's Maryland we're talking about. Even though the poll was commissioned by a liberal organization and performed by a "progressive national polling firm," I am inclined to think that its results are basically true. Marylanders like their government programs. Somewhat surpisingly, though, there are also a few chambers of commerce that support raising business taxes to pay for more government health care programs. Three state black chambers of commerce have endorsed the MCHI plan, although the state chamber is opposed to it. Democratic legislators are also skeptical of it, with Senate Finance Committee Chair Mac Middleton expressed reservations about supporting a payroll tax hike during next year's session. Were I a betting man, I'd say the odds of the MCHI plan being enacted next year are pretty slim. But I'll make a prediction that 2011 will be a more favorable year for government health care expansion in Maryland. Sen. Middleton isn't necessarily opposed to expanding Medicaid and the state government's involvement in the health care market, he just wants to make sure there's enough taxpayer money to pay for it. Two years will bring a better economy and a gap of three years before the next legislative election. Those factors mean bad news for Maryland taxpayers.
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Thursday, June 4, 2009Medicaid Shell Game Continues in OhioBy Marc KilmerCategories: Medicaid, OhioA previous post of mine discussed how Ohio politicians are trying to game the system to pull down more federal Medicaid funding. These fiscal shenanigans continue in the version of the budget to emerge from the state Senate. This budget imposes a franchise tax on providers that receive Medicaid funding, but it promises they won't feel any impact as their reimbursement rates will go up and they will receive a supplemental Medicaid payment. It's a clever game policymakers are playing -- impose a tax on providers in order for the state to increase its Medicaid spending. This increase will, of course, bring in more federal money. The entities being taxed, however, will see their tax money returned to them as soon as its been laundered by the state in order to get that federal money. The Bush Administration made moves to cut down on this tpe of activity, which it placed under the category of "waste, fraud, and abuse." I've seen no indication that the Obama Administration is interested in doing the same thing. If you want to see why federal entitement spending is going up, looking at ways the government gives incentives for states to game the system is a good place to start.
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Friday, May 22, 2009Price of Insurance in New Jersey Going UpAutism mandate likely to become law By Marc KilmerCategories: Insurance Regulation, New JerseyThe New Jersey Assembly has voted to require private insurance companies cover autism treatment. While it has yet to be voted on by the state senate, given New Jersey's love affair with goverment insurance mandates, I think it's a safe bet that this will be law in the Garden State soon. Of course, this mandate will only raise the cost of insurance for New Jersey residents. As Grace-Marie Turner pointed out in this post, "a family purchasing a health insurance policy in Wisconsin would pay about $3,087, but that policy would cost $10,398 in New Jersey." Is it really fair to ask these families to pay even more to cover treatment that may not even work?
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Wednesday, May 13, 2009Mandating Useless Services?Autism mandate may cost a lot, produce nothing By Marc KilmerCategories: Insurance RegulationI've blogged about the trend in many states to require insurance companies to cover services for autistic children. These services are frequently expensive but many parents swear they work. A doctor, however, points out that there isn't much evidence these services do any good. This points out one of the problems of mandating that insurance cover certain procedures. The decisions are based on politics, not science or what is cost effective. In some states, for instance, chiropractic services are covered, even though the evidence is clear that chiropractic "medicine" provides no benefit. The push for an autism mandate is driven by parents of autistic children who, understandably, want to ensure their children receive the best services possible. As a new parent, I sympathize. But I also understand why anecdote-driven health care is a bad thing. For instance, I have family who swear that their baby's colic was helped by an osteopath manipulating her bones. Of course, it's clear this is a sham treatment but I'll never convince them of this. For them, their baby's crying lessened (or seemed to lessen) after seeing an osteopath, so therefore the osteopath's treatment helped. Trying to discuss confirmation bias or the differences between correlation and causation with them is a losing battle. A variety of other treatments (both mainstream and alternative) suffer from the same problem: patients believe they work even when the evidence is clear they don't. Government mandates for such coverage means people with insurance will be paying higher premiums to pay for these sham treatments. (h/t to Tyler Cowen's excellent Marginal Revolution, in which he discusses this issue from another angle)
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Thursday, May 7, 2009South Carolina Squabbles over Government Health CareBy Marc KilmerCategories: Medicaid, South CarolinaSouth Carolina politicians want to expand government's involvement in health care -- they just can't agree on how to do it. A proposal to raise the state's seven-cents-a-pack cigarette tax has stalled because of objections to creating a fund to subsidize health insurance premiums:
Senate Minority Leader John Land wants to use the money to expand Medicaid instead. As he points out, the $150 million would draw $450 million in federal funding. I'm not enamored with insurance subsidies, but I think they are a better way to provide health care than Medicaid. But Sen. Land has a point -- the feds are offering all this "free" money, so why not take it? It's another illustration into the unintended effects of the current Medicaid system. What may be a good idea may be defeated because there is a pot of federal money out there if the state expand Medicaid.
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Thursday, May 7, 2009Arizona Moves to Make Health Insurance More AffordableHouse moves mandate-lite policy By Marc KilmerCategories: Arizona, Insurance RegulationWhen other states are piling on the insurance mandates, Arizona is heading the opposite direction:
Of course, in the story it references one legislator who is concerned that the uninsured would be hurt if they couldn't buy insurance that covers things like alcoholism treatment. Yes, I guess it's better they go without insurance at all rather than have coverage for a program they may never use. This bill may die in the state Senate, but it's good to know some state legislators understand the connection between government mandates and higher insurance costs.
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