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Sunday, December 23, 2007

Holiday Health Care

National health care, that is what Americans need,
NO! vested interests said, rationing will come,
We won’t be able to get the extra labs we love,
Planned delivery in our health system indeed.

Better to have legions showing up at the ER
Without insurance or basic primary care,
How much longer must the poor and vulnerable wait,
Until Medicaid funding is no longer there?

Health care is a business claimed the suppliers,
What would we do if we lose some of our buyers?
Better risk management of course, that’s what we need,
Excluding high-risk cases said company greed,

Drug distributors are worried about their pipeline,
New dependencies to create for the consumer,
Sure to fuss over medication change rumors,
Reduced supply increase the consumer whine,

Everything available to everyone does not work,
When we ought to give the right treatments without shirk.
Pass through taxes from under funding payers,
Paying much higher premiums for unfunded care,

Let’s continue to spend twenty-five percent more
For health than any other country without fail,
How much longer can this health system sustain?
Talk of health care system change makes everyone sore,

American care is already bursting at the seams,
Diabetes, mental health, and other diseases
Often unmanaged, left to patient devices,
Emergency care only for greatest extremes,

Consequences to the consumer community,
Poorer health outcomes and higher long term costs,
How apropos for the land of great excesses,
Making sense of spending and health disparity,

Health care subject to economic utility,
Little help without access to a facility.

We can get more value for our health care dollar,
But more of you are going to have to holler,
To our legislators to bring relief in sight.
Wishing Health care for all and to all a good night!

This verse was written by Roberta Winter, MHA, MPA
December 22, 2007

Wednesday, December 12, 2007

SCHIP veto, Rossi Response

Last month our illustrious president, George Bush voted not to provide health care for 900,00 low income children by vetoing the expansion of the Supplemental Childrens Health Insurance Plan, known as SCHIP. According to the nonpartisan nonprofit Kaiser Family Foundation, in 2005 there were 46.1 million people under the age of 65, without insurance in the United States. Of that group, only 25% are eligible for state Medicaid programs, including the SCHIP. Fifty six percent of the uninsured are not eligible for public health care programs but need financial assistance to purchase health insurance or health care. This means that if you are a family of four and earn more than $20,650, you are over the Federal Poverty Level. The SCHIP guidelines allows families earning no more than 200% of the FPL rate or $41,299, to apply for Medicaid coverage for their children. The proposed federal expansion for SCHIP would have allowed families with incomes up to 300% of the federal poverty level (about $61,950) to apply for Medicaid coverage for their children. The presidential veto of this legislation caused a schism among Republican legislators and considerable ire with Democratic representatives as well. The fallout of this decision was felt throughout the country, including Washington State where Dino Rossi, the loser in the last gubernatorial election and who is running for governor again commented on the President’s decision.
According to CounterIntelligence journalist, John Feit, gubernatorial candidate Rossi had this to say, "The majority of the children that are going to be coming on (to SCHIP expansion) are either illegal or currently have health insurance from the private sector." This article addresses the inaccuracies of Mr. Rossi’s statement, though one has to wonder about Rossi’s Catholicism and whether or not he is adhering to Catholic principles when he views children of immigrants who are living in this country as less valued than children who were born in America.
Here are the facts Mr. Rossi:
Your assertion that uninsured children have access to insurance coverage through private employers is wrong. The Kaiser Commission on Medicaid and the Uninsured reviewed this very question in 2007 and here is what they found:
Fact-The majority of the uninsured (56% according to the 2007 findings) are not eligible for public programs for health care and have incomes below 300% of the Federal Poverty Level. Of the six million children who live in poverty (200% of FPL), seventy percent live with families with parents who work, largely for small employers. Small employers do not offer health insurance to their employees at the same frequency as larger employers and fewer employers are offering coverage to their employees. The Kaiser Survey of Employer Sponsored Health Benefits for 2007 shows a precipitous decline in the proportion of small employers offering health insurance to their employees. For firms with fewer than ten employees, only 45% offer health insurance now, down from 56% in 1999. For all firms with less than two hundred employees, only 59% report offering health insurance today, versus 65% in 1999.
Your assertion that the expansion of SCHIP for families with incomes up to 300% of the FPL would disproportionately cover "illegals".
Fact- According to the Kaiser Commission, 85% of the pool of children who would be eligible for the SCHIP expansion are native United States citizens. Additionally, most new immigrants are excluded from Medicaid coverage during their first five years of residency, except for emergency treatment. Finally, the Deficit Reduction Act of 2005 requires residents to show proof of citizenship when applying for Medicaid, which also applies to SCHIP.
Rossi’s assumption that private employers are indeed making health insurance available and affordable for families living at 300% or less of the federal poverty level.
Fact-Most of the families who earn 300% or less of the federal poverty level are employed by small employers, many of whom do not offer insurance. According to the 2007 Survey of Employer Sponsored Health Benefits, the average cost for an individual enrolled in an employer sponsored health plan in the United States is $4,479 and $12,106 for a family of four. Since employees are usually expected to pay a significant portion of their health care premiums under private employer benefit plans, how can a family of four earning less than $ 41,300 per year afford medical insurance? The budget in this chart assumes the employee is expected to pay all of the cost for his dependents enrolled on insurance.

Family of Four Budget
Income Ceiling for SCHIP Expansion
$ 61,949

FICA & Medicare
Taxes at minimum rate after credits
Net available for living expenses
$ 49,228

Phone, cable television
Transportation-inc. repairs, insurance, parking, maintenance, payment or lease
Savings/retirement-3% minimum
School expenses
Personal care-hair cuts, etc,
Miscellaneous-repairs, etc,.
Subtotal for living expenses
$ 41,599
Net available for Health care
$ 7,629

Health Care Costs
Healthcare copayments
Health insurance premiums (employee, spouse & 2 children)
Subtotal health care expenses
$ 12,356

Net After Purchasing Health care
$ (4,727)

Since you are wrong on so many levels about your health care assumptions, is this what we can expect from your gubernatorial ambition? Next time get your facts right.

This article was written by Roberta E. Winter, MHA, MPA, who is a graduate of the University of Washington School of Public Health and the Evans School of Public Affairs.