Coverage But No Care in NJ, CA

Two recent news stories from New Jersey and California again highlight the fact that "coverage" does not equal medical care.

From the New Jersey Star-Ledger (2/5/2015): "Who will treat the flood of Obamacare Medicaid patients?"

From the San Jose Mercury News (2/7/2015): "Obamacare: Medi-Cal a waiting game for many low-income Californians".

In New Jersey, patient Justin Holstein said:

"You have a card saying you have health insurance, but if no doctors take it, it's almost like having one of those fake IDs," he said. "Your medication is all paid for, but if you can't get the pills, it's worthless."

Richard Holstein, his father, is a Long Branch psychologist who has watched his son struggle to get care. Yet he no longer accepts Medicaid in his own practice because the managed care payment of about $40 is half of what regular insurance pays, and a quarter of his full fee, he said.

Similarly, in California:

"We had a shortage of primary care doctors before this flood (of Medi-Cal enrollees) came about," said Dr. Steven Harrison, a veteran primary care doctor who directs a residency program for such physicians at Natividad Medical Center in Salinas. "Now we have a dire shortage."

A common theme in both stories: Patients were promised "coverage" under ObamaCare.  But they have a very difficult time finding a physician willing to see them, especially at the low rates that Medicaid pays.  Doctors essentially lose money on these patients, which means there is no way they can "make it up in volume".

The government even forbids Medicaid patients and doctors from reaching their own mutually-acceptable contractual arrangement to supplement Medicaid fees.  From the Star-Ledger piece:

Joanna DeProspero was desperate to find a pain management doctor for her adult daughter, who works part-time at Home Depot despite back pain. When she proposed paying cash, she learned it's illegal for a doctor to accept such a payment. Doctors who participate in Medicaid cannot bill a patient anything extra, said Downs, of the medical society -- even if that payment is freely offered by the patient.

 "I've literally cried at the end of the day after six or eight phone calls," said DeProspero...

One unfortunate side effect is that the patients end up going to the local emergency rooms instead (for care that isn't strictly an emergency), thus worsening the overcrowding situation in the ERs.

Supporters of the Affordable Care Act trumpet the increased "coverage" numbers provided by the law. But much of that increase is due to an expansion of Medicaid rolls, where the benefits are increasingly illusory for patients.

As we've seen throughout history, central planning and government fiats cannot create supplies of goods and services from thin air.  Instead, they merely create (or worsen) shortages.  Sadly, patients in New Jersey and California are paying the price for their lawmakers' ignorance of this lesson.

(New Jersey link via M.L.)

Catron: GOP Governors Squander SCOTUS Victory

An unfortunate update from David Catron: "Eight GOP Governors Squander SCOTUS Victory".

He reminds us that the 2012 Supreme Court decision

...dealt the Obama administration an important defeat on one of the two primary issues decided, namely whether the federal government has the right to withhold all matching funds from a state that fails to expand Medicaid according to the dictates of the unpopular health care law.

Medicaid is a joint state-federal program, yet a provision of Obamacare required the withholding of all federal funds from noncompliant states. The plaintiffs argued that this was so coercive that it amounted to an unconstitutional “commandeering” of the states. Seven of the nine justices agreed. This victory, despite the Court’s ruling that the individual mandate is somehow a tax, was viewed by many as an opportunity for GOP governors to thwart implementation of an integral component of the law.

To the disgust of Obamacare’s opponents, however, eight GOP governors have nonetheless decided to comply with the law’s Medicaid provision. Arizona’s Jan Brewer, Florida’s Rick Scott, Michigan’s Rick Snyder, Nevada’s Brian Sandoval, New Jersey’s Chris Christie, New Mexico’s Susana Martinez, North Dakota’s Jack Dalrymple, and Ohio’s John Kasich have all caved. Even worse, several of these people have been vocal opponents of Obamacare and govern states that participated in the lawsuit that produced the Court’s favorable ruling.

 He discusses the fiscal implications, then adds:

What makes this so infuriating is that these Republican governors are waving the white flag after winning a hard fought legal battle in order to escape this very dilemma.

 (For more details, read the full text of "Eight GOP Governors Squander SCOTUS Victory".)

PA and NJ Doctors Speak Out

As the election comes down to the wire, some doctors in Pennsylviania and New Jersey have taken out a full page ad in the Philadelphia Inquirer speaking out against ObamaCare.

As Dr. Evan Madianos explains:

It is a letter drafted and signed by myself and over 40 doctors in Pennsylvania to our patients here -- and elsewhere -- expressing our unadulterated opinions and best medical advice about how this election will impact on the future of your health care system and country. I hope you will read it. I also hope you will circulate it to others. Take it as an emergency alert.

Your current crop of inept politicians are deadly serious about their intention to  barge into our examination rooms and offices to control how we practice medicine, and dictate your care. Their plans are incompetent, irresponsible and dangerous. So your doctors have no choice but to practice politics- to get them out of our lives, out of our offices, out of your life and *OUT OF OUR WAY* -- so that we, as doctors, can practice the profession we are trained to do - which is also in your best interest as a patient.

Consider carefully -- with the full knowledge that we- as practicing physicians working daily in the system -- have the best knowledge of what is wrong with the system and how to fix it.  It is to your doctors that you come in life and death situations  and who give you the facts, straight up about a threat to your life and health -- and what to do about it. In an age where politicians distort the truth shamelessly and are emboldened to make fantastic, economically ridiculous empty promises, unrestrained by agenda-driven complicit media, you'd be a fool to trust them with the power to make life or death decisions over your health care. Choose wisely.

Here's a PDF version of their ad.

Let's hope the voters are listening.

To Cut Your Health Insurance Costs, Move

How much do state-level insurance regulations raise the costs? As Steve Malanga notes, a lot. Here are a few excerpts from, "To Cut Your Health Insurance Costs, Move":

...[T]he trade group for the nation's insurers, America's Health Insurance Plans, estimated that the average premium for family coverage in the individual market nationally was $5,800. But the study found wide disparities in costs, ranging from average premiums north of $12,000 in New York and Massachusetts to premiums costing on average only $3,000 to $5,000 in more than a dozen states. Some states have even allowed insurers to introduce low-cost, high-deductible policies that can cost under $1,000 a year.

It's fair to say that the costs imposed by some states based on how they regulate health insurance are now a bigger burden on individuals and small and mid-sized firms than state and local taxes.

...There's no evidence that states garner any benefit from such regulation and mandates. States with numerous mandates don't have healthier populations, for instance. Indeed, many state mandates are enacted for political reasons that have little to do with health care outcomes. Several years ago New York's then-Governor Pataki signed into law the state's hefty in vitro fertilization mandate as a payoff to conservative religious groups whose members favor big families and lobbied heavily for the law. It's a rather classic example of how, when you vest such power in lawmakers, some will eventually abuse it.

(Read the full text of "To Cut Your Health Insurance Costs, Move".)

These increased costs are a result of the government usurping the individual's right to spend his own money for his own benefit according to his best judgment.

Extending these onerous regulations to the national level (as the President and Congress propose) will only make the problem worse, not better.

LaFerrara on NJ Health Care Reforms

The October 14, 2008 edition of the New Jersey Star-Ledger printed the following LTE by Mike LaFerrara supporting free market health care reforms in New Jersey:

Insurance freedom

A free market is a recognition of every individual's inalienable right to think and act on his own judgment, including entering freely into contractual agreements with others for his own well-being. It leaves him free from coercive interference by others, including government officials and politicians. Anything else is a violation of those rights. The health insurance crisis is directly attributable to the lack of a free market.

Assembly Bill 2767, the New Jersey Healthcare Choice Act, would be a huge step toward rectifying this injustice. The bill would open up New Jersey's insurance market to policies offered in any state. Individuals and health insurance companies from around the country would be free to contract voluntarily to mutual advantage. Unfortunately, a hearing on this bill is being blocked in committee, according to one of its sponsors, Assemblyman Jay Webber.

Insurance Committee Chairman Gary Schaer should end this blockage. If "government of the people" means anything, Trenton should end the rights-violating restraint-of-trade practice of forbidding state residents from buying out-of-state health insurance policies and enact this bill into law.

-- Michael A. LaFerrara, Flemington

This would be a good step in the right direction. Plus, state legislatures could easily implement this reform without permission from the federal government -- all they need is the political will.

Battle in New Jersey

The May 29, 2008 Wall Street Journal describes two proposals for health care reform in New Jersey coming from opposite philosophical approaches.

The first is a proposed change in the right direction:

Jay Webber, a Republican Assemblyman in Trenton, will introduce legislation to let Garden State residents buy low-cost health insurance from any registered policy in any of the 50 states.

Mr. Webber's proposal is a state version of Arizona Congressman John Shadegg's federal legislation to let individuals buy insurance across state lines, and John McCain has also endorsed the idea. But New Jersey would be a perfect test case, because its multiple mandates have made insurance too expensive for hundreds of thousands of families.

The average national cost for a family health plan is $5,799, according to America's Health Insurance Plans, but in New Jersey that same plan costs $10,398 on average. The state's politicians have driven up these costs by forcing insurers to provide gold-plated coverage – even for such voluntary medical services as in vitro fertilization.

The second is a change in the wrong direction:

Democrats in Trenton are rallying behind a plan to require that every uninsured individual in New Jersey purchase health insurance from a new state-administered program. So a state that is already so broke that its politicians are contemplating mortgaging its highways might now add a $1.7 billion health subsidy.

The Webber proposal offers lower costs and more choices for consumers, while the Democratic plan mandates public coverage and no choice, while putting a new burden on taxpayers.

As the WSJ concludes, "This is the kind of debate the country should have this election year.""