Thursday, July 17, 2014

Medicaid Expansion: Real People, Real Lives, Real Injuries. Information Bulletin # 395 (7/2014). Too often, advocates get bogged down with “policy” formulations and do not focus on the people who are affected by these policies. Here is what is at stake for non-elderly people with incomes below 133% of the poverty level in the 24 States that have not opted to receive 100% federal reimbursement for Medicaid expansion since January 1, 2014. Chart #1 below lists the 24 States. On July 2, the White House Council of Economic Advisers (CEA) issued a report, Missed Opportunities: the Consequences of State Decisions Not to Expand Medicaid, which details the impact of states’ decisions to not expand Medicaid under the Affordable Care Act. We are talking about a lot of people whose health care needs are put at risk because the 24 States have refused to expand Medicaid: 1. Preventive health care will not occur each year - a. for 214,000 women between the ages of 50 and 64 who would have received mammograms; b. for 345,000 women who would have received pap smears, and c. for 829,000 men and women who would have received cholesterol-level screenings. 2. Also, 651,000 people who would have received “all needed care” they felt they needed during the year. 3. If Medicaid had been expanded in every State, an additional 1.4 million people would likely have had a primary care visit at a physician’s office. See Chart #2 below for a breakdown by State. Real people, real lives, real injuries. Becausee these 24 States have not accepted Medicaid expansion, 255,000 people risked facing catastrophic out-of-pocket medical expenses which would have otherwise been covered with Medicaid. Even without catastrophic medical expenses, there would have been 810,000 fewer people who had trouble paying rent and utilities because they had to pay for medical bills. Medicaid expansion thus helps people to have greater financial security in addition to improved access to health care. Finally, in addition to individuals receiving health care, let’s not forget the impact on your States’ economies because your State has opted not to have Medicaid expansion. The impact on State economies is stark: those 24 States that have not expanded since July 1, 2014 will lose $88 million in Federal payments through calendar year 2016. Those 26 States that have expanded will receive $84 million over that period. Because Medicaid expansion is funded through our federal taxes, tax-payers in the 24 States that have not opted to expand Medicaid are subsidizing the 26 States that have expanded. The federal government pays 100% of the health costs for Medicaid expansion for three years – 2014 through 2016. Thereafter, the federal government pays about 90%. It is really hard to believe and understand why any State would not accept 100% federal funds for health care for the lowest income people, other than a real enmity toward low-income people, especially when a State could opt out of Medicaid expansion for whatever reason. Advocates in the 24 States that have not expanded Medicaid should think about whether your State accepts federal highway and other infra-structure funds for bridge repairs. We bet none of these 24 States turn down those funds. Does your State turn down federal special education funds? Maybe we should not mention food stamps for fear that the apparent hatred toward low-income people would be extended to those federal funds too. Chart # 1 - Number of people denied health care in States without Medicaid xpansion Alabama 235,000 Alaska 26,000 Florida 848,000 Georgia 478.000 Idaho 55,000 Indiana 262,000 Kansas 100,000 Louisiana 265,000 Maine 28,000 Mississippi 165,000 Missouri 253,000 Montana 38,000 Nebraska 48,000 North Carolina 377,000 Oklahoma 123,000 Pennsylvania 305,000 South Carolina 198,000 South Dakota 26,000 Tennessee 234,000 Texas 1,208,000 Utah 74,000 Virginia 210,000 Wisconsin 120,000 Wyoming 16,000 Chart #2 States Without Medicaid Expansion and People who gave had No Mammograms No Pap Smears No Cholesterol Screening In Past 12 months In Past 12 Months In Past 12 Months Alabama 9,300 14,200 34,200 Alaska 900 1,500 3,800 Florida 35,300 52,000 123,000 Georgia 17,000 28,900 69,600 Idaho 2,300 3,300 8,000 Indiana 9,000 15,200 38,200 Kansas 3,100 5,800 14,600 Louisiana 10,400 16,000 38,600 Maine 1,300 1,700 4,100 Mississippi 6,200 9,700 24,000 Missouri 9,400 14,900 36,900 Montana 1,600 2,400 5,500 Nebraska 1,600 2,900 7,000 North Carolina 13,900 23,000 54,900 Oklahoma 4,800 7,300 17,900 Pennsylvania 11,100 17,600 44,400 South Carolina 8,000 12,000 28,800 South Dakota 900 1,500 3,800 Tennessee 9,500 14,000 34,100 Texas 44,100 75,200 176,000 Utah 1,900 4,500 10,800 Virginia 8,000 1,300 30,600 Wisconsin 3,800 6,700 17,500 Wyoming 700 1,100 2,300 Real people, real lives, real injuries. Steve Gold, The Disability Odyssey continues Back issues of other Information Bulletins posted after 10/2013 can be found only at Information Bulletins before 10/2013 are available online at with a searchable Archive at this site divided into different subjects. To contact Steve Gold directly, write to or call 215-627-7100. Ext 227.

Monday, July 14, 2014

People With Disabilities Institutionalized in Nursing Homes, Information Bulletin #394 (7/2014). Think about the warmth and coziness conjured up by the term “nursing homes.” Much of the public and as well as the press think that “nursing homes” are the places where people must go in order to receive intensive nursing care. Let’s take a look at the extremely effective branding of a product: nursing homes. As of December 2013, 69.4% of the nation’s 15,666 nursing homes were classified as “for profit,” only 24.7% were classified as “nonprofit,” and 5.9% were classified as “government/public facilities.” In Alabama, Arizona, California, Connecticut, Louisiana, Ohio, Oklahoma, Oregon, Texas and Utah, more than 80% of the nursing homes are “for profit.” More than 55% of these 15,666 facilities were owned by multi-nursing home chains and corporations, with each corporation having two or more nursing facilities under one ownership or operation. Nursing homes have not been “mom and pop” operations for many years. Nursing homes are a $74 billion Medicaid funded industry. Medicaid certifies about 90% of the nursing facilities. Most of these facilities are BIG BUSINESS funded by public taxes and dollars. Think BIG LOBBIES using people with disabilities as cash cows to make profits. Most of these are large institutions – not “homes,” not even “group homes” of only a few people. This is not surprising since “for profit” means making money for the owners. That means meeting the interests of the owners and not the residents in terms of size and scale. The “nonprofits” are really not that much different from the “for profits” with regard to their size. They are not “homes.” Don’t be fooled by the label “nonprofit.” Executive Directors’ salaries in nonprofit nursing homes can be hundreds of thousands of dollars or more. Senior staff in “nonprofits” also make a lot of money. What about the residents in Medicaid funded-nursing homes? They are all people with disabilities. Regardless of their age, in order to be eligible for Medicaid funded nursing homes, people must meet the State’s criteria disability consisting of physical and/or cognitive impairments that limit activities of daily living. Elderly people cannot just decide that they want to enter a Medicaid-funded nursing facility, like they would a hotel. They must have a certain number of impairments, just like younger people with disabilities. With regards to the alleged doctors, let’s examine their affiliations with the facilities. Most people in nursing homes do not know they can have their own doctors continue to treat them there. Rather, the nursing homes have an understanding or deal with certain doctors who “care for” all the residents. The result is that the doctors in nursing homes are beholden to the nursing facility, and the residents/patients in these facilities are cash cows for the doctors. These doctors do not view the residents as their patients because in order for the doctors to continue to be reimbursed, they must cater to the nursing home proprietors. We have seen the “drive by” medical care that these alleged medical professionals provide. They bill Medicaid for hundreds of alleged patient visits, as well as care and treatment for all the nursing home patients just in a few hours. In reality, they rarely even see the patients but just sign hundreds of charts. What about the “nursing” part of “nursing homes”? The general public, the press, and elected officials must think that people with disabilities, regardless of their age, really need to be in a nursing facility because they need direct care that can be provided only from well-trained health care staff in a nursing facility. Hmm. Let’s look at how much time measured in hours per patient per day residents actually receive “nursing” care and services. Nationally, the average of “total direct care” staff hours provided per patient per day is 3.71 – that a total for registered nurses (RNs), licensed practicing nurses (LPNs), and aides. However, of this average 3.71 hours per nursing home, less than half an hour is provided by a RN and about three quarters of an hour is provided by an LPN, who generally have only one year of training. Does anyone really think that a “visiting nurse” in one’s home could not provide the same patient care in the same amount of time, but much more cheaply? Who is providing this “direct care if not the RNs or LPNs?” It is the “aides.” These are the people who provide the assistance with residents’ daily living needs – transferring them from their beds, assisting them with toileting, showering, dressing, and other such needs. Yes, the assistance personal attendants provide in the nursing homes is the same assistance with activities of daily living that people with disabilities receive in the community. So why has the nursing home industry been so successful in deceiving the public? First, the nursing home industry is well-funded; they are active lobbyists and contributors to your State legislators and Governor. They play this system much better and more effectively than the community-based community-care providers. Second, advocates for the elderly and non-elderly disabled people have not developed or engaged in effective activism and advocacy. There have not been the press or television stories that were produced about institutions for people with intellectual or mental disabilities, showing how absolutely terrible they were. Third, once people with disabilities enter nursing homes, especially if they are elderly, they give up hope that they can live in the community. Their families do not know about or believe they can receive appropriate or the same services in the community that they think nursing facilities provide, and they do not fight for those services. We need a new Frederick Douglass. He knew that power concedes nothing without struggle. Where are you? Steve Gold, The Disability Odyssey continues Back issues of other Information Bulletins posted after 10/2013 can be found only at Information Bulletins before 10/2013 are available online at with a searchable Archive at this site divided into different subjects. To contact Steve Gold directly, write to or call 215-627-7100. Ext 227.