Mississippi Raises Prices of Your Sudafed

From the Clarion-Ledger: “Gov. Haley Barbour has signed House Bill 512, making any medicine that contains pseudoephedrine — a key ingredient in methamphetamine — a controlled substance as of July 1.”

That in turn will mean that if you have a routine, it-comes-every-year, easily addressable condition popularly known as “hay fever,” you’ll have to pony up for a visit to your doctor.

One judge quoted in the article blithely waved off the extra cost, which he cited as a $20 copay.

And a box of Sudafed otherwise costs, what, $10?

The Rich Get Richer: Senate’s Medicaid Proposal Gives Bigger Bailout to Wealthier States

People were rightly upset when they learned about the “Cornhusker Kickback,” the deal whereby Sen. Ben Nelson of Nebraska sold his vote in favor of the Senate’s health bill in exchange for his state never having to pay for any of the Medicaid expansion in the bill.

However, the biggest problem with the Medicaid expansion in the Senate health bill is not the “Cornhusker Kickback,” but that it leverages an already flawed formula to determine federal payments to state Medicaid programs. The Senate bill would motivate states to invest more resources in recruiting higher-income residents into Medicaid, rather than traditionally eligible beneficiaries, including the blind and disabled. The Senate bill also gives richer states a bigger Medicaid bailout than lower income ones. New Hampshire, Maryland, and Connecticut get the biggest handouts, while Mississippi, West Virginia, and Arkansas are short-changed, according to my just published analysis.

The Federal Medical Assistance Percentage (FMAP) is the federal financing formula that encourages each state to spend its own taxpayers’ money irresponsibly in order to maximize its take from other states. For example, California’s FMAP was traditionally the 50 percent minimum: For every dollar California spent, the U.S. Treasury would kick in one dollar. However, the FMAP is supposed to give more federal dollars to states with more poor people. So, Mississippi has had the highest FMAP, 75.67 percent: For every dollar Mississippi spent on Medicare, the U.S. Treasury would kick in $3.11.

The Senate bill proposes a much higher FMAP, averaging 90% nationwide, in 2019. However, the higher FMAP would only apply to the relatively higher-income, able-bodied, newly eligible, beneficiaries. People eligible under the current law will still draw the previous FMAP. States with FMAPs of 50 percent would see them increased to 82.3 percent for the newly eligible beneficiaries. Imagine yourself a county public-health bureaucrat who would attract one federal dollar for every dollar spent on a blind or disabled Medicaid beneficiary, or $4.65 for every dollar spent on an able-bodied young man. Obviously, you would invest your energy in recruiting the able-bodied youth.

Furthermore, the expanded FMAP gives more federal fiscal leverage to rich states: Each thousand-dollar increase in money income per capita is associated with a one-percent increase in the FMAP under the Senate bill, and this statistically significant regression explains over one-third of the variance in the change in FMAP.

For example, New Hampshire’s money income is $68,175 per capita, which is $16,942 greater than the national average of $51,233. Its FMAP would increase from 50 percent to 82.3 percent, an increase of 65 percent. This is 18 percent greater than it would have been if higher per capita incomes did not explain the Senate’s “generosity.” On the other hand, Mississippi’s FMAP increases by only 20 percent: From the current 74.73 percent to 95 percent. This increase is 15 percent less than it would have been if the state’s low income did not explain its poor outcome in the Senate’s FMAP allocation.

Instead of leveraging the FMAP, Medicaid reform should jettison it entirely, in favor of easily understood block grants.

U.S. Index of Health Ownership 2nd Edition Is Here

Pacific Research Institute has published the 2nd edition of the U.S. Index of Health Ownership, the only ranking of health care in the states that uses criteria of individual choice.

Americans lack the basic freedom to make their own health care decisions. The Index measures the degree to which individuals, be they patients, health professionals, entrepreneurs, or taxpayers, “own” the health care in their states.

The lack of health ownership is a real problem. Almost half of the country’s health care spending is in the hands of the government, instead of patients themselves. The other half is governed by regulations inflicted upon doctors, health plans and patients.

The Index uses 24 variables to quantify how state laws and regulations affect the liberty of citizens involved in state government health plans (primarily Medicaid), the private health-insurance market, and the provision of medical services. It also assesses the effect of medical tort on people’s freedom to engage health services.

Alabama, Montana, Nebraska, North Dakota, and New Hampshire finished in the top five, as the states that allow their citizens the highest degree of health ownership. Alabama leads the pack primarily because of a lightly regulated private insurance market, and good control of state government programs. Also, the state performs well on medical tort indicators. Alabama’s regulatory environment for providers favors competition, and government health programs run more effectively than in most states.

New York, Massachusetts, Rhode Island, Vermont, and North Carolina rounded out the bottom five, as the states in which the government has taken the most undue control of health care from its citizens. This is the second year that New York was in last place. The state suffers from government health-care programs that are out of control, a grossly overregulated private-insurance market, and almost completely uncompetitive provider markets.

A full listing of all 50 states and their rankings is contained in the Index.

The Index will give concerned citizens a good basis to demand reforms from their state politicians that will put American families in charge of American health care, instead of government and special interests.

Great Moments in Government Health Care

In the arcane world of government health care finance, some people are "dual eligibles," meaning they are both old (Medicare) and poor (Medicaid).Medicare requires premiums; Medicaid doesn't. Got that? Proceed.

In Mississippi, the state paid the Medicare premiums of 9,300 people who were on Medicaid–that is, "dual eligibles" who were in both programs, but deemed too poor to pay the Medicare premium.

But it turns out that these people should not have qualified for Medicaid in the first place, meaning that the state should never have paid for their Medicare premiums.

It's possible that these people will now have to make up the difference through having their Social Security checks docked. A "Medicaid spokesman" (not sure if this is a state employee or a federal one) says that that's unlikely, however.

Mississippi Medicaid Mess

Some people think that putting more and more people into government health care programs is the compassionate and right thing to do. So how'd you like to have your health care dependent on the outcome of political battles such as the one going down in Mississippi?

Gov. Haley Barbour and the Mississippi Legislature are at loggerheads over a new budget.

The Republican governor and leaders of the Democratic-controlled House have been at odds for weeks over how to pay for Medicaid, how much to spend on K-12 education and whether to reserve a portion of federal stimulus dollars for later years.

The new fiscal year begins on July 1.

Hospital Tax in Mississippi

The Mississippi Hospital Association and Gov. Haley Barbour are still at odds over Barbour's plans to levy a tax on hospitals.

Hidden in the story is this moral: We don't need a universal insurance mandate because the uninsured shift costs to everyone else. The far bigger cost-shift comes through government programs that chronically underpay hospitals and health care professionals, as they attempt to compensate for the fact that people who benefit from third-party payments have little incentive to exercise financial discipline or be active in their own health care.

The Financial and Political Power of Medicaid

The average person has no idea, I suspect, of the huge impact that Medicaid has on his or her state's budget. So here's an example: Mississippi–not Massachusetts, not California, not Pennsylvania–has raised its tax on cigarettes. And the governor who signed the increase: Haley Barbour, former head of the Republican National Committee, and long-time opponent of an increase.

This short article doesn't give the details (maybe I'll put in more later), but funding for Medicaid has been a big issue in the state this year, and is in large measure behind the increase. Falling tax revenues is certainly part of the equation, but so is rising demand.

Medicaid Tax a No-Go in Mississippi, for Now

Gov. Haley Barbour and the Mississippi Legislature are still at odds over a proposal to raise taxes on hospital patients to fund Medicaid.

The fund is allegedly on hospitals, but who pays the hospitals? One way or another, patients, which means that there's some cost-shifting going on, from private sector patients to the state.

Remember that next time someone crows about the "efficiency" of government-run health care programs.

Once a Year Visit Too Much to Ask?

I hate waiting in lines in government offices as much as the next person. But is it too much to ask that if you're going to be receiving health care courtesy of a government program, you show up at a government office once a year to prove that you're you, and still entitled to the services?

Some people think so in Mississippi, which is one of only a few states to have such a requirement for people in Medicaid. Granted, some people may find it difficult to get to the office (a lack of public transit in some areas was mentioned in the article). That sounds like a good opportunity for some community-minded individuals to get to work by helping fellow citizens make their once-a-year appointment.

Ditch the DSH

One category of Medicaid spending is "DSH," which is supposed to go to hospitals based on the amount of care they provide for people without insurance. (DSH is an acronym for "Disproportionate Share Hospital.")

Some hospitals in Mississippi that are not owned by government say that the DSH formula favors county-owned hospitals and leaves them holding the bag.

The Heritage Foundation recommends that policy makers "con­sider a new approach to financing that would trans­form these institutions from regular beneficiaries of taxpayer funding to active competitors for taxpayer dollars in a new and improved state-based health insurance market."