Grassroots Activism on Missouri’s Prop C

Missouri will be the first state to pass judgment, at the ballot box, on the Freedom of Choice in Health Care Act, or at least one version of it. The Missouri Watchdog reports on the goings-on of advocates on both side of Proposition C. There are a number of groups taking positions pro and con, with surprisingly little money being spent.

The Associated Press also offers up a story on the ballot question, saying, “its expected passage could send an ominous political message to Democrats seeking to hang on to their congressional majority in this year’s midterm elections.”

Medical-Tort Law: Ranking the States

How much do a state’s laws governing medical malpractice and other torts relevant to health care affect the availability of care?  Plenty!

Lawrence J. McQuillan’s & Hovannes Abramyan’s 2010 edition of the U.S. Tort Liability Index, which has a number of measurements included in the U.S. Index of Health Ownership, ranks states according to 42 variables.

Eight of the measurements in the U.S. Tort Liability Index are relevant to the U.S Index of Health Ownership: One output and seven inputs. The previous edition of the U.S Index of Health Ownership included six measurements of medical tort, but McQuillan & Abramyan have discovered more variables for their 2010 edition of the Tort Liability Index, allowing more detailed measurement.

As a partial update of the U.S. Index of Health Ownership, this brief analysis calculates a medical-tort index from a simple average of the eight relevant variables.  Mississippi, Nevada, Michigan, Colorado, and Louisiana lead the pack; while Vermont, Rhode Island, Kentucky, Pennsylvania, and Iowa bring up the rear. Even the leaders, however, lag in some measurements.

Mississippi, for example, leads on procedural rules: Pre-trial screening or arbitration and conditions on the use of expert witnesses. However, it does not limit lawyers’ ability to abuse their privilege by limiting their share of awards. Colorado and Louisiana also fail to impose limits. Unfortunately, the laggards do not show a similar pattern: The bottom five states perform poorly in all eight measurements.

Reducing the burden of medical tort is critical to increasing Americans’ health ownership and reducing medical costs that curtail our access to care. Some progress is evident, but states aiming to improve their medical-tort laws still have a long way to go.

Mississippi Legislators Seek Ballot Measure

“‘We’re just trying to keep Mississippians from being mandated into a health care plan or being forced to buy health care. It’s something we can’t afford and it’s immoral.” — That’s Mississippi Rep. Steven Palazzo, who along with Rep. Alex Monsour, are launching a petition drive to place a version of the Freedom of Choice in Health Care Act on the state ballot for the 2011 general election. It would

prohibit laws or rules from compelling any person, employer or health care provider to participate in any health care system; to permit a person or employer to pay directly for lawful health care services and to permit a health care provider to accept direct payment from a person or employer for lawful health care services; to provide that the purchase or sale of health insurance shall not be prohibited by law or rule.

The Vicksburg Post says the two politicians have quite a challenge on their hands: “Under Mississippi’s initiative and referendum process, the potential exists for the public to amend the state’s constitution, although the process, with more than 25 precise requirements, has never been accomplished.” Efforts to enact a similar law through the legislative process, led by Monsour, died in committee.

Gov. Haley Barbour has said that the state will join the multi-state lawsuit against the U.S. government over the recently enacted health “reform” law.

Doctor Shortage to Worsen in Mississippi

Do you have insurance coverage? Thanks to the health care “reform” law, you might. Will you be able to see a doctor? Not necessarily. Wait. I thought “covering the uninsured” would mean that nobody could be denied health care?

Oh, you’ll still be able to go to the ER and wait and wait and wait. Or you could try your luck finding a doctor … if you don’t mind waiting.

From Mississippi:

Mississippi already has the nation’s largest shortage of doctors. It also has more than half a million people who could gain health insurance when the law takes effect.”With more people covered, access is certainly going to be a problem,” said Dr. James Keeton, who leads UMC as the vice chancellor for Health Affairs and dean of the School of Medicine.

Repeat after me: Coverage is not care. Coverage is not care.

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.