Writes Dr. Lave:

Gov. Rendell has indicated that the fiscal year 2009 budget deficit will reach $3.2 billion. Given the size of the deficit, the state Legislature is forced to balance the budget and make difficult choices about programs to target for savings. There is conflict as illustrated by the governor’s budget and Senate Bill 850.

A concern is the special allocation to obstetric departments that serve a high proportion of mothers and newborns covered by Medical Assistance. In FY 2008-09, the Legislature appropriated $6.9 million for these payments.

The governor’s budget would reduce those payments by $2 million, while Senate Bill 850 would eliminate them. The reduction might appear minor, but funding is critical to some obstetrical departments. With 41 percent of all births in the state covered by Medical Assistance, these special allocations to obstetric departments affect access to services and ultimately the health of mothers and newborns.

Medical Assistance plays a vital role in the commonwealth by financing health coverage for low income and disabled individuals. It now covers about 16 percent of the population, a percentage that is increasing because of the recession.

Under federal law, the Medical Assistance program must cover low-income pregnant women. However, recognizing the importance of healthy mothers and babies, the Legislature created a more generous program for pregnant women than was required. Under this program, Medical Assistance pays for prenatal and obstetrical care for otherwise uninsured women with family incomes up to 185 percent of the federal poverty level, or about $20,000 for an individual in 2009.

Read the rest of the op-ed at the Patriot.

Democratic leaders in Pennsylvania hope to double the number of residents who receive state-sponsored health insurance, known as adultBasic, but Republicans fear the costs may be too high.

The Pennsylvania House on Monday voted, 104-98, in favor of HB 1, to increase the number of individuals receiving adultBasic from 45,000 to 90,000.

Republican leaders in the Senate say they might oppose the effort. Carolyn Scanlan, president and CEO of the Hospital & Healthsystem Association of Pennsylvania, also expressed reservations.

…

AdultBasic is designed for people who earn too much to qualify for poverty programs such as Medicaid but can’t afford insurance themselves.

An individual is eligible for adultBasic if he or she earns $21,600 or less; a family of four can earn $44,000 or less.

The program can’t begin to meet the rising need. The waiting list, officials say, is growing by 20,000 a month and projects 270,000 as of today.

A year ago, it was at 96,000.

Ann Torregrossa, director of the Governor’s Office of Health Care Reform, says the cost of expanding adultBasic – $130 million – will be paid with federal Medicaid funds available through a special waiver.

…

Republicans, however, say the expansion will cost state taxpayers money. They also question the wisdom of expanding the program when the state faces a $3 billion budget shortfall.

Read much more about the battle at the Inquirer.

First up was a discussion of the state’s Pay-For-Performance (P4P) initiative, enacted in 2005.  P4P changed Medical Assistance reimbursement practices to physicians and health care facilities to determine reimbursement rates based on their patient outcomes, rather than the quantity of patients they saw.  The goal has been to incentivize physicians and hospitals to keep patients healthy, rather than move patients through as quickly as possible.

There’s been talk of dismantlying P4P– but at the meeting, this was not brought up directly.

Kevin Casey, the Deputy Secretary of the Office of Developmental Programs, spoke about about issues in dealing with mentally retarded adults, whose parents can no longer take care of them.  He discussed the lack of any real, current solutions to the issue. 

Peter Adams, Deputy Commissioner for the state Children’s Health Insurance Program (CHIP), then spoke about the proposed CHIPRA State Plan Amendment, explaining the reasoning behind the proposed changes.

The Deputy Secretary of Medical Assistance, Mike Nardone, then spoke about the overall state of the DPW.  He said that Gov. Rendell’s proposed personal income tax increase is needed for the DPW. 

Joan Erney, Dep. Sec. of the Office of Mental Health and Substance Abuse Services, said that SB 850’s cuts to mental health programs would be devastating to the dept’s programs.

The amendments to CHIPRA will address new mandates, and implement options that the Federal CHIP law recently authorized to be made to state CHIPs.

Before the changes can be made, the state will have to submit the State Plan Amendment to the Centers for Medicare and Medicaid Services, telling them how the changes will be implemented.

Among the changes already mandated by CHIPRA are that newborn children are automatically enrolled in CHIP for 1 year if the children is born to a targeted low-income woman who was receiving pregnancy-related assistance through CHIP when the child was born.

CHIPRA options authorized by the Federal government that PA will pursue include:

- Adding more low-income pregnant women to the targeted population

- Implementing Express Lane Eligibility to enroll children

The Insurance Dept. will be presending the CHIP State Plan Amendment to the Medical Assistance Advisory Committee this morning.  They’re accepting comments on the amendment through June 27, to be sent to:

Peter J. Adams, Deputy Commissioner for CHIP and adultBasic, Insurance Dept., Office of CHIP and adultBasic, 333 Market St., Lobby, Harrisburg PA 17120, or RA-PA-INS-Benefit-Pr@state.pa.us

Check out the full CHIP State Plan Amendment.

The American health-care system needs to change. But with more than 8 percent of Pennsylvanians out of work, government cuts that would weaken the health-care safety net are not the changes we need.

Last year, the number of Pennsylvanians covered by Medical Assistance – the state’s version of Medicaid insurance for low-income residents – rose at three times the expected rate. In a little more than a year, the region has seen a 10 percent increase in Medical Assistance enrollment. Hospitals report more people turning to their emergency rooms for health care. And government-subsidized health centers are caring for more uninsured people.

But the budget plan recently passed by the state Senate – and, to a lesser degree, the one proposed by Gov. Rendell – would reduce health-care services for those who need them most.

The Senate’s budget would eliminate additional proposed subsidies for low-income families purchasing health coverage through the Pennsylvania Children’s Health Insurance Program. It would also put about 2,000 older Pennsylvanians in nursing homes, costing taxpayers twice what it would to keep them safe and comfortable at home with community-based services.

The Senate legislation would make large cuts to Medical Assistance, including funding for essential services such as obstetrics. Many of these reductions would fall on people with disabilities, denying them the services they need to lead independent lives.

By reducing support for screening and prevention, the proposal could also delay detection and treatment of cancer and other serious diseases.

Read the rest of the op-ed.

The Pa. Senate passed a budget that is a big step back in caring for the disabled and ill.

The American health-care system needs to change. But with more than 8 percent of Pennsylvanians out of work, government cuts that would weaken the health-care safety net are not the changes we need.

Last year, the number of Pennsylvanians covered by Medical Assistance – the state’s version of Medicaid insurance for low-income residents – rose at three times the expected rate. In a little more than a year, the region has seen a 10 percent increase in Medical Assistance enrollment. Hospitals report more people turning to their emergency rooms for health care. And government-subsidized health centers are caring for more uninsured people.

But the budget plan recently passed by the state Senate – and, to a lesser degree, the one proposed by Gov. Rendell – would reduce health-care services for those who need them most.

The Senate’s budget would eliminate additional proposed subsidies for low-income families purchasing health coverage through the Pennsylvania Children’s Health Insurance Program. It would also put about 2,000 older Pennsylvanians in nursing homes, costing taxpayers twice what it would to keep them safe and comfortable at home with community-based services.

The Senate legislation would make large cuts to Medical Assistance, including funding for essential services such as obstetrics. Many of these reductions would fall on people with disabilities, denying them the services they need to lead independent lives.

By reducing support for screening and prevention, the proposal could also delay detection and treatment of cancer and other serious diseases.

Both budget proposals also mean cuts for hospitals. In the best of times, Pennsylvania hospital margins are about 4 percent, on average. Today these margins have fallen off a cliff, having dropped an unprecedented 12 percentage points in two years.

The Senate’s budget would exacerbate hospitals’ financial challenges by cutting Medical Assistance payments by about $280 million (nearly 10 percent), $167 million in the Philadelphia area alone. The governor’s budget calls for a reduction of $75 million statewide and $40 million in the region.

These cuts would result in more job losses. This year, one Philadelphia hospital has already closed its doors as a general acute-care facility. More may well follow.

The saddest aspect of these cuts is that they are totally unnecessary. Pennsylvania is eligible for up to $4 billion in additional Medicaid funding from the federal stimulus package. For every dollar the state spends on Medical Assistance, the federal government contributes about $1.60. To maximize its share of federal stimulus dollars, Pennsylvania must fund Medical Assistance, not cut it.

We urge the public to oppose cuts to Medical Assistance and other health-care safety-net services. Please tell your local and state representatives that you reject any reductions to these services in next year’s state budget.

——————————————————————————–
Ken Braithwaite is regional executive of the Delaware Valley Healthcare Council and senior vice president of the Hospital & Healthsystem Association of Pennsylvania. Laval Miller-Wilson is executive director of the Pennsylvania Health Law Project. Their e-mail addresses are kbraithwaite@dvhc.org and lmillerwilson@phlp.org. Seven other health-care advocacy groups join in their opinion.

Baer writes:

YOUR LEGISLATURE is about to get another chance – the fourth in four years – to approve a piece of health-care reform that could save taxpayers $146 million a year.

Seems simple, especially as lawmakers face a $2 billion-plus budget deficit. But it steps on the toes of drug companies and health insurers, both big donors of campaign cash.

So, does the Legislature in economic hard times side with saving taxpayers or continue coddling its often-generous benefactors?

Here’s the deal.

The Department of Public Welfare wants to directly buy prescription drugs for 1.2 million Pennsylvanians receiving medical assistance, more than half the medical-assistance population, 371,000 of them in Philly.

If the department buys meds for these folks, nothing changes for them, not the doctors, not the drugs, but the state gets federal rebates that dramatically cut its costs, hence the $146 million saved per year.

The idea isn’t new. Twenty states do it and four more are moving that way.

In each of the last three years our Legislature killed the proposal.

When I ask Welfare Secretary Estelle Richman why, she says, “I wish I could answer that one.”

I take her to mean she knows the answer and wishes she could say it.

That’s because the sale of meds in question ($500 million-plus) is in the hands of managed-care groups such as the Blues, and drug companies – hands that know how to take, and give.

…

So what will the Legislature do this year?

A spokesman for House Democrats says, “We’re weighing all of our options.”

A spokesman for Senate Republicans says the issue “hasn’t been fully ventilated to date.”

Check out Baer’s entire column.

…U.S. Agriculture Secretary Tom Vilsack [has] announced an increase in nutrition benefits for low-income families in Pennsylvania.

As of April 1, state recipients of the Supplemental Nutrition Assistance Program (SNAP) will receive an additional $700 million in monthly benefits.

Philadelphians will collect $200 million of that total, part of President Obama’s Recovery and Reinvestment Act of 2009. Nationally, $20 billion will be released for the nutrition program.

The city’s $200 million will generate almost double that in total economic activity here, Vilsack said. According to U.S. Department of Agriculture estimates, every $5 in new SNAP benefits funnels $9.20 to local businesses.

…

With 63 percent of the country’s adults and 35 percent of its children overweight or at the risk of being overweight, eating healthier will lower health-care costs, he said.

Read more at the Inquirer.

More than 50,000 Erie County residents — 18.4 percent of the total population — qualify for Medicaid but do not participate in the government-funded health insurance for the poor.

A new report published by the Erie Community Foundation also found that about 3,500 Erie County children qualify for the state’s Children’s Health Insurance Program but are not enrolled.

“Many of them either don’t know that they qualify, or they don’t know how to navigate through the process,” said Shiloh Turner, the Erie Community Foundation’s vice president of programs.

…

Read much more at the Erie Times-News.

Rep. Tony DeLuca, D- Allegheny, will hold a news conference at 11 a.m. Wednesday, March 11 in the Capitol Media Center to discuss legislation (H.B. 642) he has introduced that would impose a 6 percent tax on political advertisements to help fund the state’s adultBasic health insurance program.

AdultBasic is administered by the state Department of Insurance. The program provides health insurance to qualifying uninsured Pennsylvanians between 19 and 64. There are more than 200,000 Pennsylvanians on the current adultBasic waiting list.

DeLuca said revenues from the proposed tax would not eliminate the adultBasic waiting list but would significantly reduce the waiting list so that more uninsured Pennsylvanians would have access to affordable health insurance.