In a confusing health care landscape, probably the most misunderstood sector is one of the biggest — Medicaid.
Many Americans receive their health insurance through their employers.
Americans 65 and older often rely on Medicare, a single-payer system run by the government through private servicers.
Some Americans receive their health care through the military, either through TriCare or the Veterans Administration.
Some Americans with individual insurance receive coverage through federal exchanges under the Affordable Care Act.
And a few people must use cash-only payments through the individual market.
Then there is Medicaid. As described by Kaiser Health News, it does much more than cover poor people.
• It covers public health emergencies and disaster relief. Medicaid paid for lead tests of Flint children. In fact, Medicaid covers 39 percent of American children.
• It pays for nearly half of all births in the nation.
• It pays for nursing home services for 60 percent of residents.
• It pays for 25 percent of mental health spending and 20 percent of substance abuse treatment.
In fact, Medicaid covers 74 million Americans, more than 1 in 5 of us.
Because it is such a large program, it would be wrong to connect Medicaid to only low-income people.
About 60 percent of non-disabled adults on Medicaid have jobs. Though it seems unpopular in the Florida Legislature, Medicaid is popular nationally.
About 3 in 4 Americans have positive views of it, according to a scientific poll conducted by the Kaiser Family Foundation.
This includes 84 percent of Democrats and 61 percent of Republicans.
STATE EXPERIMENTS
One of the keys to reforming an overly expensive health sector is allowing states to conduct experiments that pair quality and cost.
Massachusetts, for instance, is asking Washington for the authority to negotiate discounts for the drugs it purchases and to exclude drugs with limited therapeutic value.
This is nothing more than the formularies used by private health insurance plans.
Medicaid spending on prescription drugs in Massachusetts increased by 25 percent in 2014 and nearly 14 percent in 2015, reported Kaiser Health News.
Massachusetts officials correctly contend that Medicaid’s reimbursement plan encourages price inflation since there is a legal requirement to cover most prescriptions and a set reimbursement schedule.
Of course, like any formulary, there needs to be an appeals process that allows a patient and a physician to request coverage of a prescription that is off the formulary list.
Meanwhile, California has become the third state to require drug makers to explain increases in prices. This simply is transparency, it doesn’t involve any price controls.
It’s a bill that is only needed for a few outrageous price increases that have shocked the nation, such as a 5,000 percent hike.
PERKS FOR CONGRESS
Members of Congress who come down with the flu don’t have to brave Washington traffic to make it to the nearest drug store. They have a sweet perk.
For an annual fee of $600 they can visit a medical clinic staffed by Navy doctors with pharmaceuticals provided by Grubb’s, one of Washington’s oldest drug stores.
And, of course, it’s an absurdly cheap perk, too.
Since 1992, the annual fee for members of Congress to use the elite medical clinic has increased by only $80 — and its pharmacy fills as many as 100 prescriptions a day, reports Statnews.com.
It’s time for the clinic to be eliminated — and for the $3.7 million budgeted for it each year to be returned to the federal treasury. Let D.C. lawmakers experience the health system the same way the rest of the nation does.
THE DIRTY SECRET
One of the favorite health plans for Republicans involves high-deductible health insurance plans paired with health savings accounts.
But as Drew Altman of the Kaiser Family Foundation writes, many Americans do not have ready cash to handle the co-pays required in these plans.
“Many low-income and moderate-income Americans simply don’t have $1,500 to $3,000 to pay for the colonoscopy that might save their lives, or a stress test that might reveal the heart disease that is the cause of their chest discomfort,” Altman wrote.
For many families, even those with insurance, any major illness can wipe out their savings.
CANCER PREVENTION
We know so much about preventing cancer now.
Here are some tips from The Los Angeles Times:
Don’t smoke: Lung cancer is the deadliest cancer by far. This is a major success story since only 15 percent of Americans smoke, down from a high of 42 percent in the 1960s.
Lose weight: Extra pounds raise the risk of at least 13 cancers such as breast, colon and pancreas. Body fat weakens the immune system, for example. Extra weight around the waist is especially risky.
Exercise: Exercise gains lean mass and loses fat. It reduces the risk of more than a dozen cancers, especially breast, colon and uterine. Recommendations include 2 ½ hours of moderate aerobic activity and 75 minutes of vigorous activity per week.
Protect your skin: Skin cancers are becoming more common. Indoor tanning is one cause. Another tip is to use plenty of sunscreen and reapply often.
Easy on the alcohol: The American Cancer Society suggests two drinks a day for men and one for women.