Timmy Parks is a fourth-generation farmer and has lived in Clairfield all his life, in the house where he grew up. He got the last of four stents in his heart 13 years ago but hasn't had them checked since because he can't afford it. He also hasn't gotten recommended surgery for blocked arteries. Things got even worse for Parks late last year, when he was helping a friend drill a hole and hit a rock, twisting his arm.
He suffered a heart attack on the way to the hospital and was transferred to another, where doctors amputated his arm above the elbow. Parks has sold off most of the animals on his acre farm and borrows heart pills from his brother because he can't pay for his own.
TennCare, One State's Experiment with Medicaid Expansion [Christina Juris Bennett] on waysenneukneb.tk *FREE* shipping on qualifying offers. A history of the. Editorial Reviews. Review. "Bennett offers a detailed case study of medical system reform in the state of Tennessee viewed through the perspective of the.
A couple of miles away lives Charlie Pittman, a year-old former strip miner and truck driver who survived a heart attack and 10 strokes and mini-strokes but now can't afford the medicines he's been prescribed to prevent more problems. And Julie Johnson, a former hospital phlebotomist and brain tumor survivor with severe diabetes, hepatitis C, epilepsy and blood clots. At 45, she lives with her year-old mother, who came out of retirement to work as a teacher so she could pay the family's bills.
Johnson has thought about moving to Kentucky for the insurance but says "there'd be no way to come up with the money" to relocate. Daniel Yoder, a family doctor at a community health center in Clairfield, says half of his patients are from Kentucky, half from Tennessee, so he sees firsthand how health care varies state to state. He sees more foot ulcers and kidney problems from advanced diabetes in his Tennessee patients — costly on both human and financial terms. When people who are uninsured put off care for chronic conditions, many experts say, everyone pays through higher medical bills and insurance premiums.
Mark Wilson, director of civic learning initiatives at Auburn University in Alabama, was in Clairfield recently leading a group of student volunteers. He says expanding Medicaid is a moral imperative that helps all of society. If Tennessee and other states did so, 5, deaths would be avoided every year because people would have better access to care, concludes a report from the Council of Economic Advisors. To function as a society, we have to think of ourselves in community terms. When poor people move forward, then everyone moves forward. President Obama visited Tennessee early this month as part of a campaign to get more states to expand Medicaid.
Rick Scott of Florida recently announced that he dropped a lawsuit against the federal government over Medicaid expansion after reaching an agreement with the Obama administration about federal hospital funds. There are new signs of growing accord in some places. Under the original TennCare framework, the cost of care for the uninsurable was to have been offset by the premiums paid by the uninsured—a healthier group, in general. Indiana and New Hampshire are slated to start implementing Medicaid work requirements in January Commins, John. Louis Fed will only respond to comments if we are clarifying a point.
Bill Haslam rejected the Obamacare model of expansion, instead proposing an alternative called Insure Tennessee, which included financial incentives and disincentives to encourage healthy behaviors. Tennessee's hospitals committed to cover the state's cost to implement the plan so it wouldn't further burden the strapped state budget. But after a conservative group backed by the billionaire Koch Brothers waged an aggressive campaign against Haslam's plan, a state senate committee blocked it from going forward.
Across the border in Kentucky, the expansion of Medicaid has brought coverage to more than , low-income residents, including Robert Otto, a year-old community college student with severe back problems who used to go to the ER for care and spent much of his time in bed. Now, he's going to the doctor regularly and working toward an associate's degree in psychology. But there have been drawbacks as well. Some doctors won't accept new Medicaid patients, so finding a physician can be tough.
Opponents of expanding Medicaid say the government program is too flawed to solve many health care problems. Avik Roy, a health care adviser to Mitt Romney during his presidential bid, believes the poor deserve the same insurance plans offered by the state and federal exchanges that everyone else can get.
There are at least 10 studies in medical journals showing that Medicaid patients fare better than those who are uninsured. But there are just as many studies showing they do the same or even worse. Researchers say that's because patients often can't get in quickly — if at all — to see doctors who accept Medicaid. Notoriously low reimbursement rates are a key factor along with a persistent shortage of primary care physicians in some of the states that have expanded their Medicaid programs.
The federal Department of Health and Human Services has approved dozens of grants to states that are testing ways to improve the quality of care in their Medicaid programs. Keeping costs under control at the state level is another struggle. The report predicted costs covered by states will be the same or lower than previously predicted by the fiscal year. In Rhode Island, an expansion state, newly elected Gov.
In non-expansion state Virginia, Republican State Rep.
Rob Bloxom says time has shown that Medicaid expansion was a very risky proposition for many states. Bloxom's overwhelming victory last year was called a referendum on expanding the program. Bloxom's office is just about 10 miles from the border of Maryland, where the poorest residents can get free health care thanks to former Democratic governor Martin O'Malley. But soon after Republican Gov. Larry Hogan took office in January, he proposed cutting some pregnant women from Medicaid and lowering reimbursements for doctors to keep costs down.
The budget approved by the Democratic-controlled Legislature put the money for doctors and pregnant women back in, but Hogan waited weeks until he reluctantly agreed to release the money for Medicaid. At a June 22 press conference where he announced he had "very advanced and very aggressive" lymphoma, Hogan further surprised health care advocates when he called health coverage "critically important. In response to a question, he said: "I would hate to be someone without access to health care, without access to insurance to get the kind of news I got last week.
Medicaid was signed into law on July 30, , by former president Lyndon Johnson, who proclaimed that day that American tradition "directs us never to ignore or spurn those who suffer untended in a land that is bursting with abundance. Like today, states could opt in or out of the program.
Participating states could receive federal funds as long as they covered eligible groups and offered specific benefits — and they could expand their programs over time. More than half of the states signed up immediately. Within two years, 37 states had signed on, with all but two joining by the four-year mark.
The program grew substantially over the years and covers the elderly, blind and disabled, poor pregnant women and infants and, with the Children's Health Insurance Program in , children from low-income families. Many states chose to expand Medicaid beyond the minimums — and costs began to rise. A consulting industry of sorts developed to help states with "revenue maximization" tactics to get as much as possible from the federal government for their Medicaid programs. Each change brought more rules, and dealing with Medicaid today is like playing a "three-level chess game with all the federal requirements," says David Brinkley, secretary of the Maryland Department of Budget and Management.
Without the law, Vaughn Adams of Salisbury, Md. He was laid off over a year ago from a job as a parents' assistant at a school and became eligible soon after. You're talking about test after test after test. The State legislature has responded in by advancing a bill that would impose work requirements on those eligible for coverage under the expansion. To implement these requirements, the state will have to receive approval from the federal government. Illinois : Then-Gov. Approximately , low-income Illinois residents will be newly insured under the expansion.
Indiana : The federal government on Jan. In a major concession, federal authorities allowed Indiana to lock residents out of the program for six months if they fail to pay premiums. Iowa : On Dec. Terry Branstad R announced that his administration and the White House had agreed on the final details of his plan to expand Medicaid. The state promised that it will not drop individuals' coverage if they fail to make payments. The agreement also allows the state to use federal funding under the ACA to help more than , low-income residents purchase private health coverage through the new Iowa Health and Wellness Plan.
Kentucky : Then-Gov. Steve Beshear D in expanded Medicaid in Kentucky via executive order. The order was challenged in court, but on Sept.
Bevin in August submitted to HHS a proposal to alter the state's Medicaid expansion, including by implementing new cost-sharing requirements and eliminating coverage for dental and vision services. Kentucky became the first state to win federal approval to test work requirements for Medicaid beneficiaries, a decision that was blocked by a federal judge in June. HHS is deciding whether to appeal the decision, but Bevin has threatened to dismantle the state's expansion if courts do not allow the work requirement to be implemented.
Louisiana : On Feb. But in June , the Louisiana state Legislature passed a veto-proof bill to create a funding plan for Medicaid expansion, in part by allowing the Louisiana Hospital Association's members to pay for a portion of the state's costs. In November , Louisiana voters elected state Rep. John Bel Edwards D to be the state's next governor. On his second day in office—Jan.
In February , the Louisiana Department of Health announced that more than , individuals had enrolled in coverage under the state's Medicaid expansion. Maine : Gov. Paul LePage R has vetoed Medicaid expansion bills passed by the state Legislature five times since , and lawmakers have failed to override his vetoes.
On Nov. But LePage, a longtime opponent of Medicaid expansion, vetoed the bill and said he will not implement the expansion without adequate funding for the effort. In June, LePage appealed a court order that would require the state to move forward with the expansion, but the order was upheld in August and the state moved forward with submitting their expansion plan to the federal government. Still, the matter of funding remains contentious, especially as the Maine Attorney General's Office signed a brief supporting a lawsuit which claims that LePage has broken the law by continuing to oppose the expansion.
Maryland : On May 5, , then-Gov. Officials projected about , state residents would enroll in the expanded Medicaid program in fiscal year Massachusetts : On July 5, , then-Gov. Under current Gov. Charlie Baker R , the state in September submitted a waiver request seeking to move certain enrollees into subsidized exchange plans to curtail state Medicaid spending. Michigan : Gov.
Rick Snyder R on Sept. Minnesota : Gov. Nebraska : In May , Republicans in the Legislature filibustered the Medicaid expansion, which was also opposed by then-Gov. Dave Heineman R. The expansion could have extended Medicaid coverage to up to 80, residents. In July, state legislators sued to claim the initiative's wording violated state law, but the suit was dismissed by a district court and the state Supreme Court in September.
Under the measure, the state will expand Medicaid coverage to an estimated 90, Nebraska residents.