Monthly Archives: June 2017

Theres often a disconnect between Washington and the rest of the country, and Medicaid reform is no exception. The House of Representatives last month passed a bill including major Medicaid reformseither a per capita spending cap or a block grant for states. The new presidential administration has pledged its support for added state flexibility for running Medicaid programs.

All that sounds nice, you might be thinking, but what does it meanboth for states, and for Medicaid recipients themselves? A recent paper I compiled for the Wyoming Liberty Group provides some sense of what a reformed Medicaid program might look like. The overhaul being contemplated in Washingtonthe largest in more than half a centurywould, if done correctly, give states flexibility to modernize Medicaid and provide better care to patients, which could end up saving taxpayers money.

Medicaid reform means better care for patients. It means states can choose the best care options for beneficiaries without worrying about checking bureaucratic boxes. That freedom will allow more elderly and disabled beneficiaries to stay in their homes, rather than moving to nursing institutionsthe preferred option for most seniors, and a more economical one.

A series of reforms in Rhode Island begun nearly a decade ago provide some sense of what Medicaid transformation can accomplish. Nonpartisan analysts found that Rhode Islands reforms saved tens of millions of dollars, while improving members access to more appropriate services. Providing better care not only represents good policyit can also save taxpayers money.

Medicaid reform could mean new efforts to coordinate care. Recent innovations from the private sectorsuch as payment bundles for all the costs of a procedurewould give providers more incentives to provide effective care the first time, while publicly releasing de-identified patient data would give providers the analytic tools they need to become more efficient.

Medicaid reform also means more consumer-oriented options for patients. It involves giving patients the tools to save money for taxpayers, then sharing some of those savings with them. Whether providing incentives for healthy behaviorssimilar to the Safeway model popular with many large employersor encouraging patients to shop around for non-emergency procedures like MRIs, these incentives can present a win-win proposition to both patients and taxpayers.

A reformed Medicaid program means providing links to employment, and employment-based health insurance, for eligible beneficiaries. Work requirements and job training programs will encourage individuals to develop translatable skills that will improve their employment prospects, and ultimately benefit the economy. Encouraging patients to accept employment-based insurance wherever offered, and transforming Medicaid so it more closely resembles employer plans, will create smoother transitions for beneficiaries.

Finally, a reformed Medicaid program would serve as a wise steward of taxpayer dollars. Enhanced eligibility checks and increased asset recovery efforts would preserve scarce taxpayer resources for the vulnerable patients who need them most. With improper payments in the program having risen by nearly 25 percent to more than $36 billion last fiscal year, state Medicaid programs need the resources and incentives to ferret out this waste and fraud and return it to taxpayers.

While Medicaid serves an important purpose for the needy populations for which it was designed, the program needs updating to respond to twenty-first-century medicine. Moreover, with the size of Medicaid nearly tripling as a percentage of state budgets over the past three decades, an unreformed Medicaid program will continue to crowd out other important state spending priorities like law enforcement, education, and transportation.

Medicaid reform may well take different forms in different states. Wyomings large rural population impacts its health system in numerous ways. Managed care has yet to come to Medicaid, and social isolation in rural communities helps explain why Wyoming has an above-average percentage of aged beneficiaries in nursing homes. These unique characteristics mean that the solutions that work for Medicaid recipients in Cheyenne may not work for those in Charlotte, and vice versa.

But given freedom from Washingtonfreedom that should be forthcoming under the new administrationevery state can transform its Medicaid program. All it takes is federal flexibility, and for policy-makers to embrace a vision for a modern Medicaid system. With a comprehensive waiver, Wyomingand every other statecan transform and revitalize Medicaid. Its time to embrace the opportunity and do just that.

Jacobs is founder and CEO of Juniper Research Group, a policy consulting firm based in Washington. He's on Twitter @chrisjacobshc.

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States Need Freedom From Washington To Transform Their Medicaid Programs - The Federalist

WASHINGTON As their counterparts in the Senate struggled Tuesday to advance a high-profile health-care bill, House Republicans confronted their own critical failure to agree on a fiscal 2018 budget resolution.

Passing a budget is about much more than next years spending for Republican lawmakers. It also sets the stage for special budget procedures known as reconciliation instructions that will allow Republicans to pass major legislation without a filibuster from Senate Democrats.

But even the promise of tax reform and long-term spending cuts has not yet been enough to bring a fractious group of House Republicans together. A scheduled Thursday meeting of the House Budget Committee to prepare a budget resolution for a floor vote was canceled Tuesday amid continued infighting.

Rep. Steve Womack, R-Ark., a Budget Committee member, lamented Tuesday that the budget should have been put to bed a long time ago.

Its almost like were serving in the minority right now, he said. We just simply dont know how to govern.

House leaders struck an optimistic note last week after Republican defense hawks and deficit hawks appeared to agree on a compromise figure of $621 billion for defense spending in fiscal 2018. But another thorny issue has derailed the talks: how much entitlement spending to trim from the federal budget over the coming decade.

Most Budget Committee Republicans are prepared to trim $200 billion from the federal budget over 10 years, but hard-line conservatives are pushing for even more cuts to federal spending that now totals roughly $4 trillion a year.

Rep. Mark Meadows, R-N.C., chairman of the House Freedom Caucus, said he has personally identified $300 billion of potential cuts to mandatory spending programs such as Medicare and Medicaid that are not appropriated on a regular basis by Congress. In particular, he said, conservatives want cuts to the federal Supplemental Nutrition Assistance Program food stamps as well as Temporary Assistance for Needy Families, the main welfare program.

To suggest that theres no waste or inefficiencies in those areas would defy history, he said.

But the chairmen of the House committees that would be charged with wringing out those inefficiencies are balking at being essentially ordered around by the Budget Committee, and that has talks in a fresh stalemate as a week-long July 4 holiday recess approaches. Under the typical yearly budget cycle, the House and Senate pass a budget resolution by April 15.

Budget Committee spokesman Will Allison said the panels chairman, Rep. Diane Black, R-Tenn., is 100 percent committed to getting a budget done and plans to keep this process moving after the July 4th recess.

House Minority Leader Nancy Pelosi, D-Calif., on Tuesday attacked what she described as the Republicans fiscal irresponsibility.

Almost five months into the Trump Administration, House Republicans still havent met their most basic responsibility to pass a budget, she said in a statement. Time is quickly running out to avert a catastrophic default on the debt.

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House Republicans struggle to pass budget - Press Herald

WAVERLY -- As part of Superintendent Randy Richards' amended contract with the Waverly Central School District, the district will pay the retiring school official's health insurance in full until 2020.

A copy of Richards' amended contract was provided to the Morning Times following the filing of a Freedom of Information Law (FOIL) request.

The new language calls for the district to "provide to the superintendent family health insurance for the 2017-2018, 2018-2019 and 2019-2020 fiscal years."

The amendment notes that the benefits will match those offered to the district's other administrators in active service.

The health insurance plan offered by the district is the "MVP Option A" offered by the NY44 Health Benefits Plan Trust.

According to the original contract between Richards and the district, the superintendent would be responsible for 15 percent of the health insurance premium, while the district picked up the remaining 85 percent.

However, the amended contract calls for the district to cover 100 percent of insurance's premium for the next three years, according to school board President Parvin Mensch.

According to district Business Manager Kathy Rote, that translates to a cost of $22,584 for the next school year.

"That's the only solid number we have right now," she said Tuesday.

If the cost of health insurance were to rise 7 percent in each of the following two fiscal years -- which Rote stressed was only a guess -- it would translate to a cost of approximately $24,000 and nearly $26,000 for those respective school years.

Richards will not receive any other benefits, such as salary, as part of his retirement, Mensch added.

The superintendent's retirement, which is set to go into effect on June 30, was announced June 15 after a lengthy executive session by the school board.

Richards still had a year remaining on his original contract after being awarded a one-year extension in November 2016.

Mensch stated that Richards' decision to retire came after it was unexpectedly discovered that the superintendent was eligible for an early retirement due to his past military service.

GST BOCES is currently searching for the district's new superintendent.

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District to pay Richards' health insurance for next three fiscal years -- Cost to district next school year is over $22K - Morning Times

New Hampshire continues to hold true to its motto, first coined by Revolutionary War General John Stark, Live free or die. As we gather together next week to celebrate our nations enduring freedom on the Fourth of July, we are reminded that this motto can take on many different meanings.

During the legislative session that recently came to a close, we looked to our Live free or die New Hampshire sensibilities of freedom teamed with practicality in all that we did, supporting a healthy balance of fiscal conservatism, need to grow our economy, yet we also provided our communities with the resources they need for a strong future.

Providing steadfast leadership in conjunction with our ability to work together with members of the House, Senate and with our governor, we have produced a number of major accomplishments on behalf of our state.

Growing our economy and creating jobs continues to be one of our top priorities this session through maintaining a business-friendly environment. As part of an ongoing effort to grow our economy and create jobs, we noted the success previous tax cuts have had, as our unemployment is among the lowest in the country, New Hampshire has the fourth fastest growing economy in the country and business tax revenues were well over projections. With the support of the House and governor, we worked together to take further steps to provide additional tax relief for businesses again this year. We also increased the deduction for capital investments to $500,000 to encourage businesses to grow and create jobs. These policies are part of a comprehensive push to drive our economy while sending a clear message that New Hampshire is open for business.

We also took an important step toward reducing our states high energy costs by eliminating the electric consumption tax. This is a move in the right direction to reduce energy costs that are 40 percent higher in New Hampshire than the rest of the nation and the top reason major employers have moved out of state. It is clear that we need to do more to cut energy costs.

It is essential that we also focus on building a well-educated and skilled workforce to fill the high-tech industry jobs in our state. I honestly believe that should begin with our students, which is why we provided funding in this budget for FIRST robotics programs in schools in addition to establishing full-day kindergarten programs in every community in our state.

We also included a new scholarship program introduced by Gov. Sununu, which would assist New Hampshire students who attend colleges and universities, public or private, in state. The goal is to keep these individuals in state after college working in the jobs available here. We know that providing opportunities for early education and emphasizing engagement in STEM programs early on, and introducing scholarship programs for New Hampshire students will better prepare them for their future and for the great opportunities available to them in our state.

Improving our states infrastructure, including roads and bridges, as well as protecting our water resources, are also key components to our future. We sent $36 million back to taxpayers in our communities to make critical road and bridge infrastructure repairs that support small businesses and our citizens. In addition, weve revamped the drinking water and ground water commission so they are entrusted with providing communities access to funding for essential drinking water remediation. Modeled after LCHIP, we made changes to allow for public-private partnerships and ensure that communities are also invested in the solution. Maintaining modern and safe road infrastructure and water resources are essential to attracting businesses and families to our state, ensuring that New Hampshire remains one of the best places to live and work in the country.

Weve also taken steps to launch the Lakeshore Redevelopment Planning Commission in Laconia to bring in new ideas for the Laconia State School property. Weve used the same framework as the Pease Development Authority to provide a platform for realizing development opportunities to benefit the Laconia region and the state. I believe the sky is the limit for the type of economic growth the city of Laconia could see in the future. This is just one example of how we are able to make progress growing our local economy through smart, tested programs that will benefit our communities.

Our state motto takes on so many different meanings, but ultimately emphasizes the importance of our freedom from oppression and perhaps overstates the need for consistent, measured practicality.

If only Gen. Stark could see New Hampshire today not only can we celebrate our independence with now-legal firecrackers, but Id like to think he would be proud of our ability to balance the need to maintain our freedoms while serving our communities on this 241st Fourth of July.

(Chuck Morse, a Salem Republican, is the New Hampshire Senate president.)

Link:

Sen. Chuck Morse: A real 'Live free or die' session - Concord Monitor