Closing Medicaid/SOS Loophole: Implications for Pain?

[drusso]

G.O.P. Targets a Medicaid Loophole Used by 49 States to Grab Federal Money

States have long used taxes on hospitals and nursing homes to increase federal matching funds. If Republicans end the tactic, red states could feel the most pain.

www.nytimes.com

“It’s a way that the state is basically just creating federal money out of thin air,” said Brian Blase, the president of the Paragon Institute and the author of a recent paper that analyzes some of the most elaborate ways states exploit the loophole. In Arizona, legislators established a hospital tax in 2020 that allowed it to increase hospital payments by more than $1 billion, without spending any additional state funds. Mr. Blase is encouraging lawmakers to reform the system as part of their budget bill.

In its simplest form, the tax maneuver works like this: When a Medicaid patient goes to the hospital, the federal government and state usually share the costs. The ratio varies from one state to another, depending on how poor the state is, but the federal government often pays around 60 percent of the bill."

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[SSdoc33]

i read this story.

if this goes through, it will hurt the indigent and hospitals.

that is what drusso wants, after all.

 

[drusso]

i read this story.

if this goes through, it will hurt the indigent and hospitals.

that is what drusso wants, after all.

A more substantive answer is that it will reshape SOS, require "non-profit" hospitals to provide genuine charity care, and help reform lopsided incentives. Say goodbye to 60-min ESI's in the HOPD.

 

[SSdoc33]

A more substantive answer is that it will reshape SOS, require "non-profit" hospitals to provide genuine charity care, and help reform lopsided incentives. Say goodbye to 60-min ESI's in the HOPD.

i do 6, sometimes 7 ESIs/hr at the hospital, but i digress.

its nice that you have a goal to work towards. sort of like an ant trying to push a boulder up a mountain, but you keep at it. hospital lobby has more $$$ than the private practice folks

hospital chains will shutter poorer performing hospitals and limit access to medicaid populations. there will be a tipping point where hospital based care will be so poor that there will be an outcry. we are not there yet, though.

 

[Ducttape]

9 of the most affected states are red states. MS, SC, UT, AL, NH TN, IA, KS, NV, MO

interestingly, the 4 least affected are also red states. SD, ND, AK, NE (and Alaska)

A more substantive answer is that it will reshape SOS, require "non-profit" hospitals to provide genuine charity care, and help reform lopsided incentives. Say goodbye to 60-min ESI's in the HOPD.

still chasing ghosts, eh?

 

[au bon pain]

Every time I hear about a proposal that would hurt the poor in the setting of large tax cuts for the rich, I can’t help but think about what the vibe was like in France before their revolution began.

Yes, these tax loopholes are dumb and should probably be replaced with something more legit. But the premise of reducing care for 20% of the poorest Americans (in order to keep more money in the pockets of the wealthiest in our society) sounds like a bad idea.

And this would absolutely hamstring rural care even more than it already is.

If the politicians really wanted to try to save money while helping patients and doctors in the process, their lowest-hanging fruit would be to create special taxes on legit for-profit corps and private equity groups that operate medical practices and hospitals.

 

[hyperalgesia]

G.O.P. Targets a Medicaid Loophole Used by 49 States to Grab Federal Money

States have long used taxes on hospitals and nursing homes to increase federal matching funds. If Republicans end the tactic, red states could feel the most pain.

www.nytimes.com

“It’s a way that the state is basically just creating federal money out of thin air,” said Brian Blase, the president of the Paragon Institute and the author of a recent paper that analyzes some of the most elaborate ways states exploit the loophole. In Arizona, legislators established a hospital tax in 2020 that allowed it to increase hospital payments by more than $1 billion, without spending any additional state funds. Mr. Blase is encouraging lawmakers to reform the system as part of their budget bill.

In its simplest form, the tax maneuver works like this: When a Medicaid patient goes to the hospital, the federal government and state usually share the costs. The ratio varies from one state to another, depending on how poor the state is, but the federal government often pays around 60 percent of the bill."

It's a good first step.

They need to completely untangle state and federal contributions to healthcare programs. If there is any federal contribution at all, it should be RELATIVE to other states. So at least one state should get zero federal dollars.

It makes no sense to tax residents of a state and then give the money back to the state. It's just more opportunity for waste, fraud and abuse.

 

[drusso]

Every time I hear about a proposal that would hurt the poor in the setting of large tax cuts for the rich, I can’t help but think about what the vibe was like in France before their revolution began.

Yes, these tax loopholes are dumb and should probably be replaced with something more legit. But the premise of reducing care for 20% of the poorest Americans (in order to keep more money in the pockets of the wealthiest in our society) sounds like a bad idea.

And this would absolutely hamstring rural care even more than it already is.

If the politicians really wanted to try to save money while helping patients and doctors in the process, their lowest-hanging fruit would be to create special taxes on legit for-profit corps and private equity groups that operate medical practices and hospitals.

https://bizj.us/1qmpc4

"For too long, insurance companies, large health systems, and other powerful entities within the system have operated with impunity, protected by ineffective regulations, captured regulators, opaque decision-making processes, and well-heeled lobbyists. Meanwhile, patients and doctors navigate convoluted complaint procedures that rarely yield meaningful resolutions when grievances arise. This design ensures that power remains concentrated in the hands of a few while those harmed by their decisions have little recourse."

 

[au bon pain]

https://bizj.us/1qmpc4

"For too long, insurance companies, large health systems, and other powerful entities within the system have operated with impunity, protected by ineffective regulations, captured regulators, opaque decision-making processes, and well-heeled lobbyists. Meanwhile, patients and doctors navigate convoluted complaint procedures that rarely yield meaningful resolutions when grievances arise. This design ensures that power remains concentrated in the hands of a few while those harmed by their decisions have little recourse."

Your article is well written. Should definitely add insurance companies into the group with for-profit and PE healthcare operators that should have to pay extra taxes and/or be legally neutered out of existence or changed to actually be a low-cost facilitator of care vs a profit hungry impediment to care.

 

[SSdoc33]

https://bizj.us/1qmpc4

"For too long, insurance companies, large health systems, and other powerful entities within the system have operated with impunity, protected by ineffective regulations, captured regulators, opaque decision-making processes, and well-heeled lobbyists. Meanwhile, patients and doctors navigate convoluted complaint procedures that rarely yield meaningful resolutions when grievances arise. This design ensures that power remains concentrated in the hands of a few while those harmed by their decisions have little recourse."

say what you want about drusso's politics, but the dude can write. kudos for not mentioning SOS at all in the article. i agree with the content this time as well

 

[drusso]

say what you want about drusso's politics, but the dude can write. kudos for not mentioning SOS at all in the article. i agree with the content this time as well

My politics are now considered mainstream by any standards.

 

[SSdoc33]

My politics are now considered mainstream by any standards.

any standards at the Qanon convention maybe

 

[DrSpine]

What private practice physicians need to do is get in the ear of RFK Jr. It's time we stand together to put an end to this corrupt matrix that exists.

 

[drusso]

What private practice physicians need to do is get in the ear of RFK Jr. It's time we stand together to put an end to this corrupt matrix that exists.

These conversations are happening.

 

[SgtThunderfistMD]

What private practice physicians need to do is get in the ear of RFK Jr. It's time we stand together to put an end to this corrupt matrix that exists.

And just hope it's the worm listening