Dead But Not Gone From Government Rolls

Posted on November 2, 2010 by Tom Schuman

There’s the old joke (well, not really a joke in some cases) about dead people casting their ballots in elections. Now, it appears the dead are collecting taxpayer money in another example of government gone awry.

The National Center for Policy Analysis reported the following:

About $1 billion in taxpayer money goes to 250,000 deceased individuals, according to a review of reports by the Government Accountability Office, inspectors general and Congress itself. How, might you ask? According to Sen. Tom Coburn’s, R-Okla., office:

The Social Security Administration sent $18 million in stimulus funds to 71,688 dead people and $40.3 million in questionable benefit payments to 1,760 dead people.

The Department of Health and Human Services sent 11,000 dead people $3.9 million in assistance to pay heating and cooling costs.

The Department of Agriculture sent $1.1 billion in farming subsidies to deceased farmers.

But that’s not all, says the Washington Examiner:

The Department of Housing and Urban Development overseeing local agencies knowingly distributed $15.2 million in housing subsidies to 3,995 households with at least one deceased person.

Medicaid paid over $700,000 in claims for prescriptions for controlled substances written for over 1,800 deceased patients and prescriptions for controlled substances written by 1,200 deceased doctors.

Medicare paid as much as $92 million in claims for medical supplies prescribed by dead doctors and $8.2 million for medical supplies prescribed for dead patients.

Hijacking the $timulus Dollars

Posted on September 2, 2010 by Tom Schuman

Whether one agrees with the philosophy behind federal stimulus money, it is difficult to argue with the practice of accepting the dollars once they are offered. If you (as a state) turn away the cash, it will go somewhere else.

Another story is how to use the funds, particularly in the case of the soon-to-be-arriving education stimulus. One can make a strong argument for a cautious approach; in other words, why go out and spend now when you’re likely going to need it even more later?

State Superintendent of Public Instruction Tony Bennett put it this way when informing school districts how much they should receive come November. (The federal law says the money does not have to be spent until September 2012).

"With your staffs and budgets set for the 2010-2011 school year, I urge you to be careful with how and when you spend these funds. Please consider reserving this one-time funding until the level of resources budgeted by the General Assembly in the upcoming budget cycle become clearer."

That won’t be clear until late April in 2011, if then.

While timing may be a consideration, I suspect that taking the education dollars and using them to fill a Medicaid budget gap was not what those doing the allocating had in mind. But that appears to be the case in Rhode Island. The Providence Journal reports:

Instead, Governor Carcieri intends to use the $32.9 million Rhode Island is eligible to receive to plug an estimated $38-million deficit in this year’s budget.

His plan drew a strong protest from Education Commissioner Deborah A. Gist, Congressman James R. Langevin and representatives of teachers unions and the state’s school committees.

School districts across the state were hoping that more than 400 teaching jobs would be restored or protected after Congress passed the bill in August. Nationwide, the law allocates $10 billion for schools and $16.1 billion to prevent Medicaid cuts.

Rhode Island is eligible to receive more than $100 million, $32.9 million intended for education jobs and about $70 million for Medicaid reimbursements.

But that’s about $38 million less for Medicaid than the state was counting on when it passed the 2010-11 budget, said Carcieri’s spokeswoman, Amy Kempe.

“While I’m sure it may be technically allowable and that the governor’s office is doing the appropriate thing, I don’t think we are acknowledging the intention of President Obama, [U.S. Education Secretary Arne] Duncan or Congress had for these funds,” Gist said.

Gist said she is especially concerned because the state is facing an even worse budget gap in fiscal year 2012 and the education jobs money could be spent during that year as well. According to the state Budget Office, the overall deficit could be as large as $320 million next year.

The executive director of the National Education Association of Rhode Island also criticized the governor’s plan, particularly after Carcieri and the General Assembly reduced state education aid to schools by 3.6 percent this year, a $29-million cut.

“I voted for this bill to help keep Rhode Island teachers on the job,” Langevin said in a statement. “Properly supporting our state’s education system is the best way to reverse our current economic situation over the long term.”

Officials at the U.S. Department of Education said Tuesday that using the federal money to supplant state funding is not expressly prohibited, although they cautioned they will carefully review each state’s application to ensure it follows the guidelines.

Congress Gives States More Money; Indiana’s Share Estimated at $434 Million

Posted on August 16, 2010 by Bill Waltz

Just before heading home for its August recess, the U.S. Senate passed a $26 billion mini-stimulus that it struggled with for months. And House leadership decided to call its members back from recess to act on the legislation, which has two main components: (1) $16.1 billion to extend increased Medicaid funding for states (what is referred to as FMAP or Federal Medical Assistance Percentages); and (2) another $10 billion said to be needed to prevent teacher layoffs.

The debate involved both fiscal prudence and the perceived benefit of these state subsidies, as well as the specifics of how to pay for them. Proponents say $9 billion is to be generated from a "provision that closes corporate tax breaks on income earned overseas." Proponents think this ends an incentive to "export jobs overseas." A different – and more accurate – description would be that this is nothing more than a tax increase for businesses that happen to employ workers both in the U.S. and overseas.

The debate took its own politically charged form in Indiana this week, as efforts were made to characterize Gov. Daniels as inconsistent on the FMAP funding issue. He and 42 other governors sought the funding in a joint letter from the National Governors Association, with some qualifying statements, back in February, but Gov. Daniels has consistently pointed out the detrimental effects of the federal government continuing to spend money it doesn’t have while putting this particular legislation in that category.

The federal package would provide an estimated total of $434 million to Indiana: $227 million for six months of additional FMAP funding (an extension of provisions in the American Recovery and Reinvestment Act, aka the stimulus bill) and another $207 million under the teacher funding element. A $227 million subsidy to our state finances would be helpful as the General Assembly prepares for what all agree will be a brutal budget session in 2011. And school districts no doubt would welcome the money as they grapple with their budgets. But, the situation seems to pit practicality against principle. Regardless of your philosophy or political affiliation, the question remains: Why shouldn’t Indiana citizens and businesses who pay federal taxes receive the benefit of money that the federal government insists on distributing?

Throw Away Those Prescription Pads!

Posted on July 22, 2010 by Tom Schuman

I’ve written a few stories for BizVoice magazine on electronic medical records during my tenure here at the Chamber. Over the last few years, I’ve asked three different physicians (our longtime doctor moved too far away and the first choice apparently skipped the bedside manner/communicate with your patients class in medical school; thus, three family docs) about their use of EMRs.

The paraphrased responses, in no particular order: not using them and don’t ever plan to; been using for about a year but it’s been a painful transition; and they are the greatest thing in the world. The latter seemed particularly efficient as she zipped off a prescription to the pharmacy while we were wrapping up our conversation.

E-prescribing is the focus of a new national report. According to the Center for Studying Healthy System Change, few doctors were e-prescribing advocates or using the advanced features that are available. The caveat is that the survey represents 2008 use, a year before federal incentives before put into place and prior to additional government emphasis on all things electronic in health care delivery.

Here’s a portion of the study release and link to the full report.

Even when physicians have access to e-prescribing, many do not routinely use the technology, particularly the more advanced features the federal government is promoting with financial incentives, according to a new national study released today by the Center for Studying Health System Change (HSC).

Slightly more than two in five office-based physicians reported that information technology (IT) was available in their practice to write prescriptions in 2008, the year before implementation of federal incentives, according to the study funded by the Robert Wood Johnson Foundation (RWJF). And, among physicians with e-prescribing capabilities, about a quarter used the technology only occasionally or not at all.

The study also found that fewer than 60 percent of physicians with e-prescribing capability had access to three advanced features included as part of the Medicare and Medicaid incentive programs—identifying potential drug interactions, obtaining formulary information and transmitting prescriptions to pharmacies electronically—and less than a quarter routinely used all three features.

“Adoption of e-prescribing remains low, particularly among the half of all physicians who work in solo or two- to five-physician practices, said study author Joy Grossman, Ph.D., an HSC senior researcher. “And, among physicians with e-prescribing capabilities, many do not use the technology routinely, and even fewer use advanced e-prescribing features routinely.”

Insurance by the Numbers

Posted on April 21, 2010 by Tom Schuman

When the subject these days is health care, that dreaded six-letter "r" word that ends in "form" usually follows. Let’s skip that topic and its consequences. Instead, a few interesting insurance facts, courtesy of The Council of State Governments and its annual The Book of the States.

Top five states for percentage of residents covered by insurance: Massachusetts (97%), Hawaii (92.5%), Wisconsin (91.8%), Minnesota (91.7%) and Maine (91.2%)
Bottom five states for percentage of residents covered by insurance: Texas (74.8%), New Mexico (77.5%), Florida (79.8%), Mississippi (81.2%) and Louisiana (81.5%)
On a regional basis, percent insured are 88.6% in the Midwest, 88.5% in the East, 83.9% in the South and 82.8% in the West
Where people get their insurance: 53.7%, employer; 13.2%, Medicaid; 12.1%, Medicare; 4.9%, individual
People under age 65: 65% have private insurance and 17% are uninsured
Children under age 18: 58% have private insurance, 34% are on a public health plan and 8.9% are uninsured

What do all the numbers mean? Let us know your interpretation.

Overhauling Medical Malpractice Laws the Right Thing to Do

Posted on October 12, 2009 by Candace Gwaltney

Malpractice changes have been ignored, for the most part, in the health care reform discussion – now there are numbers to back why this needs to be a part of the solution.

The Congressional Budget Office (CBO) recently released data estimating government spending on programs such as Medicare, Medicaid and the Children’s Health Insurance Program would decrease by $41 billion over a 10-year period with proper reforms. The reason: Physicians would no longer overuse tests as a way to protect themselves from lawsuits.

Changes in the malpractice system would also cut national health care spending by 0.5% a year ($11 billion in 2009). No, that doesn’t solve all the problems, but trying to fix the lawsuit-happy world we are living in is a step in the right direction.

CongressDaily reports the CBO’s analysis is based on a few reform factors such as capping noneconomic damages at $250,000 and punitive damages at $500,000. It also calculated the numbers based on a one-year statute of limitation for adults and three years for children from the time the injury is discovered.

A few senators rightly shared their support for reform (and dismay for dawdling Democrats), CongressDaily shares:

"This is an important step in the right direction, and these numbers show that this problem deserves more than lip service from policymakers," said Sen. Orrin Hatch, R-Utah. "Unfortunately, up to now, that has been all the president and his Democratic allies in Congress have been willing to provide on these issues." Hatch had requested the updated analysis from CBO.

Senate Finance ranking member Charles Grassley and National Republican Senatorial Committee Chairman John Cornyn of Texas also expressed disappointment that Democrats have not cracked down on medical liability issues. Cornyn urged senators to "take account of the CBO’s objective numbers and the experience of Texas and other states where healthcare access and affordability have been improved by setting reasonable limits on lawsuits against doctors."

Democrats are reluctant to cap payouts from medical liability lawsuits. But President Obama recently directed HHS Secretary Sebelius to look at ways to make changes to the system that will bring down spending.

CBO’s analysis makes a clear argument that malpractice reform should be part of health care reform discussions. Still, supporters have their work cut out for them based on this outlandish comment:

The findings "reiterate what we’ve always known: that medical malpractice claims have almost no effect on overall healthcare spending," said American Association of Justice President Anthony Tarricone. "The vast majority of empirical evidence suggests that there are only minuscule savings to be found in reforming our nation’s civil justice system."

Inside the Uninsured Numbers

Posted on August 21, 2009 by Tom Schuman

What do we know about the health care uninsureds in our country? That there are somewhere around 46 million people in this category, the national total is slightly over 16% and Indiana’s percentage is nearly the same.

Gallup, the polling people, have some more numbers. Their recent surveys tell us there are more uninsured in Texas, New Mexico and Mississippi (between 24% and 27% in each state) and the lowest totals are in Massachusetts (5.5% with its "universal" coverage), and Vermont, Minnesota and Hawaii (all in the 8.5% range). The Gallup results also show regional trends — lower numbers of uninsured in the Northeast and higher figures in the South and West. They link varying amounts of Hispanic populations as one of the reasons for the difference.

But there are more numbers that should not be forgotten: 45% of the uninsured are in that status for less than four months and only 16% are uninsured for more than 18 months. According to the Heritage Foundation, 20 million are in households with incomes more than twice the poverty level, approximately nine million are on Medicaid and nearly as many are illegal immigrants. The problem, experts say, is the lack of portability in insurance (those who change jobs often go in and out of the uninsured count). Policy changes regarding tax treatment and portability would be a huge first step in the right direction.

The point: Yes, the many Americans without insurance is a problem and part of the health care reform debate, but take a closer look at the numbers before forming your opinion on what needs to take place.

Cato Scholars: Stimulus Could Lead to Scams to Make Madoff Blush

Posted on July 21, 2009 by Matt L. Ottinger

Here’s an uplifting gem from the folks at the Cato Institute. They assert President Obama’s stimulus package (and health care plan) could end up leading to major scams to seize money from the federal government — scams in which we’d all be investing. They speculate:

Government fraud has been in the news lately because analysts are expecting major abuses of the Obama administration’s $787 billion stimulus plan. One Deloitte expert argued that "swindlers, con men, and thieves could siphon off as much as $50 billion" of stimulus funds, which are vulnerable because policymakers are under pressure to shovel it out the door quickly.

Even more troubling is the potential for fraud and abuse created by President Obama’s other big spending proposals — particularly his giant health-care plan. Obama wants to inject hundreds of billions more tax dollars into federal health care instead of fundamentally reforming Medicare and Medicaid — broken programs that are already subject to Madoff-sized larceny. That is incredibly unfair to those of us paying the bills.

Take Medicare. The Government Accountability Office reports that the program makes about $17 billion in improper payments each year. And that doesn’t include problems in the new $60-billion-per-year prescription-drug plan, which is a juicy target for criminals. Harvard University’s Malcolm Sparrow, a specialist in health-care fraud, recently testified to Congress that official estimates are "lacking in rigor," are "comfortingly low and quite misleading," and exclude many kinds of fraud and abuse. He thinks that as much as 20 percent of the federal health-care budget is consumed by fraud, which would be $85 billion a year for Medicare.

Medicare makes a staggering 1.2 billion electronic payments each year, making it highly vulnerable to cheating by health-care providers and organized-crime rings. Criminals need only fill out the government forms carefully and the "claims will be paid in full and on time, without a hiccup, by a computer, and with no human involvement at all," according to Sparrow. A perfect example is the recent case of a high-school dropout in Miami who was able to single-handedly bilk Medicare out of $105 million from her laptop by submitting 140,000 separate claims for equipment and services.

So what do you think? Do you expect this to happen or do we all need to stop worrying so much?

The High Costs of (this kind of) Health Care Reform

Posted on June 8, 2009 by Matt L. Ottinger

The Small Business & Entrepreneurship Council recently pitted rhetoric against facts when it comes to big government health care reform. Sadly, it seems it’s the taxpayers and businesses who are losing in that fight. Read on:

Let’s consider the cost issue. Government programs like Medicaid and Medicare, for example, have run far ahead of what the original cost projections were. That’s not surprising. When the taxpayer is the funder, no one involved in the actual transaction – consumer, provider, politician, and bureaucrat – has any reason to care about prices or utilization. If cost concerns do come up – when politicians initially set up the program, or down the road when facing huge shortfalls and/or an inevitable taxpayer backlash – the usual action is a combination of price controls and rationing of care.

So, the results of more government in health care are both increased costs and diminished quality of care.

That’s all in the mix in the current debate over health care reform. But let’s just take a look at what politicians are talking about initially to fund more government care.

President Obama floats the figure of $630 billion over 10 years. But the Obama budget makes clear that the "$630 billion is not sufficient to fully fund comprehensive reform." In fact, estimates for the coming decade for the President’s plan range up to more than three times higher.

What possible tax increases are in the mix?

First, the President plans on limiting tax deductions for higher income earners, many who happen to be investors and entrepreneurs. President Obama also proposes a variety of other costs largely focused on business, including jacked up tax enforcement, repealing the LIFO accounting method, and higher death taxes.

On May 20, the Senate Finance Committee came up with a long list of possible tax hikes to pay for health care "reform." One would limit the tax deduction for employer-provided health care plans. That, of course, would increase costs for employers and/or workers.

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