Americans are on the move. They're leaving various cities and states to avoid high taxes, crime, high costs of living, and to seek better jobs; or, to simply retire. The downside to this is potential bankruptcies as the tax bases shrink; leaving cities and states with expensive pensions and other commitments that are left over from a time when populations were much higher.
This was certainly the case in the now-bankrupt Detroit. In 1950, that city's population was 1.8 million. By 2013, it had only 700,000 residents. But, Detroit's problems -- as the largest city in Michigan -- are taking that state along with it. Right now, Michigan is on the verge of losing one of it's Congressional seats due to it's slowing growth. As a state with nearly 10 million residents, the population increased by only 6,270 from 2014 to 2015; according to the Census Bureau.
Illinois is in a similar "state" of affairs. It, too, is close to losing a Congressional seat to some other faster growing states like Texas. Key to the loss there, is the fact that its largest city, Chicago, is shrinking in size. New York state is also losing people, but in its case, many of those leaving are high end earners. Even the weather-desirable California is seeing its population growth slowing. The fact is that 8 states have growth rates of less than 1/2 of a percent and well below the inflation rates for running the state's expenses.
We are getting very close to an actual bankruptcy of the entire State of Michigan, and not just a single city like Detroit. Not far behind are Cleveland, Pittsburgh, St. Louis, and Youngstown, Ohio who have all seen losses greater than 50% from their peak populations. The list of all the cities (see references) that have lost populations is substantial. As a result, people located in those areas are bound to see higher taxes as the legislatures try to cope with increased costs and a lower tax base. Raising taxes would only cause even more people to leave. This is a serious spiral that America cannot afford. The city/states that are effected need to rethink ways to restore population without raising taxes or we will all wind up paying higher taxes to bail them out.
References:
The Incredible Shrinking Illinois: http://www.chicagomag.com/city-life/February-2016/Where-Is-Illinois-Losing-Population/
Chicago area sees greatest population loss of any major U.S. city, region in 2015: http://www.chicagotribune.com/news/local/breaking/ct-chicago-population-record-loss-met-20160324-story.html
Taxpayers are fleeing New York in droves: http://nypost.com/2016/09/15/taxpayers-are-fleeing-new-york-in-droves/
The Decline of Detroit: https://en.wikipedia.org/wiki/Decline_of_Detroit
Mich. population rebound is slowing, census shows: http://www.detroitnews.com/story/news/local/michigan/2015/12/22/mich-population-rebound-slowing-census-shows/77746798/
Once a boom state, California sees a historic period of slow population growth: http://www.sacbee.com/site-services/databases/article69054977.html
Warning: New Jersey in Midst of Millennial Outmigration: http://www.njspotlight.com/stories/16/02/15/new-report-warns-that-new-jersey-is-in-midst-of-millennial-outmigration/
New Jersey Herald: Time to address population loss: http://www.njherald.com/article/20160327/ARTICLE/303279973#
List of U.S. states by population growth rate: https://en.wikipedia.org/wiki/List_of_U.S._states_by_population_growth_rate
Shrinking cities in the United States: https://en.wikipedia.org/wiki/Shrinking_cities_in_the_United_States
Showing posts with label states. Show all posts
Showing posts with label states. Show all posts
Friday, September 30, 2016
Friday, June 20, 2014
Medicaid: Increasingly, Healthcare In Name Only
Most Democrats consider Medicaid one of the major triumphs of progressive politics in the last 50 years. So much so, that as part of ObamaCare, the Medicaid roles would be expanded to include those who's incomes are up to 38% above the federal poverty level. Paul Krugman, the economist of all things liberal, once wrote in 2013: "I Have Seen The Future, And It Is Medicaid." Now, it is being reported that several Democrats are going to make it a point to run on the expansion of Medicaid as part of their election/reelection efforts in the fall.
But, Medicaid has a big problem: Access to healthcare.
Because Medicaid is the second highest state expense, just behind education, and because the states are responsible for determining the reimbursement rates for services provided by healthcare providers, state legislatures, for years, have been hacking away at those rates in their constant efforts to control costs and balance budgets. As a result, you have this 2008 map which shows a state like California only reimbursing at a rate of 38 cents on every dollar that private insurers must pay for the same services rendered by primary care physicians:
In essence, the underpayment by Medicaid is like squeezing a balloon. When Medicaid squeezes down on one end, it must expand elsewhere to compensate. So, as a result, anyone with private insurance winds up paying for the costs that Medicaid doesn't cover. However, if the insurers balk and won't pick up the additional costs then, the healthcare provider has no other option but to refuse to take on any new Medicaid patients. And, that is increasingly the case today, despite the Democrat's grand plan to expand Medicaid.
In a recent study by a healthcare advisory group, Merritt Hawkins, in a random polling of doctors in 15 major cities who were practicing the 5 most common specialties (cardiology, dermatology, obstetrics-gynecology, orthopedic surgery and family practice), the study found that only 45.7% of those doctors would accept new Medicaid patients. This was down from 55.4% in 2009. But, more importantly, the polling for this study took place before the ObamaCare Medicaid expansion of January 2014.
Understand, that 45.7% is an average. When you dig down into the survey results, you find out that Medicaid patients needing specialized treatment are basically left out in the cold. For example, only 63 cardiologists of the 262 contacted accepted new Medicaid patients. That's only 24% or about 1-in-4. Only 15% percent of orthopedic surgeons and only 17% of ObGyn's were willing to take on any new Medicaid patients.
Don't expect the situation to get any better. Last year, 8 states passed legislation that would further cut reimbursement rates as of January 1 of this year. California passed a 10% cut into law. Before that, in 2012, thirteen states cut their rates and, there is no reason to believe that the "cutting" won't just go on into the future.
So, the Democrats can praise Medicaid all day long, but it is another failed social program that is broken and not repairable; except at a great cost by forcing states to pay full-fare for services rendered.
References:
Medicaid Expansion: http://obamacarefacts.com/obamacares-medicaid-expansion.php
Democrats to amp up calls for Medicaid expansion in campaigns: http://www.dailykos.com/story/2014/06/04/1290854/-Democrats-to-amp-up-calls-for-Medicaid-expansion-in-nbsp-campaigns
I Have Seen The Future, And It Is Medicaid - Paul Krugman: http://krugman.blogs.nytimes.com/2013/09/21/i-have-seen-the-future-and-it-is-medicaid/?_php=true&_type=blogs&_r=0
Physician Appointment Wait Times and Medicaid and Medicare Acceptance Rates: http://www.merritthawkins.com/uploadedFiles/MerrittHawkings/Surveys/mha2014waitsurvPDF.pdf
Democrats Tout Medicaid Expansion In Campaigns: http://www.kaiserhealthnews.org/Daily-Reports/2014/June/04/medicaid-expansion.aspx
2012: States Cutting Medicaid: http://www.kaiserhealthnews.org/stories/2012/july/25/medicaid-cuts-chart.aspx
Medicaid surge triggers cost concerns for states: http://www.foxnews.com/politics/2014/05/26/medicaid-surge-triggers-cost-concerns-for-states-101039544/
California Cuts Medicaid Payments Amid Wave of New Users: http://www.bloomberg.com/news/2013-10-04/california-cuts-medicaid-payments-amid-wave-of-new-users.html
New Study: Expanding Medicaid Reduces Access to Health Care: http://www.forbes.com/sites/aroy/2012/03/10/new-study-expanding-medicaid-reduces-access-to-health-care/
But, Medicaid has a big problem: Access to healthcare.
Because Medicaid is the second highest state expense, just behind education, and because the states are responsible for determining the reimbursement rates for services provided by healthcare providers, state legislatures, for years, have been hacking away at those rates in their constant efforts to control costs and balance budgets. As a result, you have this 2008 map which shows a state like California only reimbursing at a rate of 38 cents on every dollar that private insurers must pay for the same services rendered by primary care physicians:
 | |
| Click on Image to Zoom |
In a recent study by a healthcare advisory group, Merritt Hawkins, in a random polling of doctors in 15 major cities who were practicing the 5 most common specialties (cardiology, dermatology, obstetrics-gynecology, orthopedic surgery and family practice), the study found that only 45.7% of those doctors would accept new Medicaid patients. This was down from 55.4% in 2009. But, more importantly, the polling for this study took place before the ObamaCare Medicaid expansion of January 2014.
Understand, that 45.7% is an average. When you dig down into the survey results, you find out that Medicaid patients needing specialized treatment are basically left out in the cold. For example, only 63 cardiologists of the 262 contacted accepted new Medicaid patients. That's only 24% or about 1-in-4. Only 15% percent of orthopedic surgeons and only 17% of ObGyn's were willing to take on any new Medicaid patients.
Don't expect the situation to get any better. Last year, 8 states passed legislation that would further cut reimbursement rates as of January 1 of this year. California passed a 10% cut into law. Before that, in 2012, thirteen states cut their rates and, there is no reason to believe that the "cutting" won't just go on into the future.
So, the Democrats can praise Medicaid all day long, but it is another failed social program that is broken and not repairable; except at a great cost by forcing states to pay full-fare for services rendered.
References:
Medicaid Expansion: http://obamacarefacts.com/obamacares-medicaid-expansion.php
Democrats to amp up calls for Medicaid expansion in campaigns: http://www.dailykos.com/story/2014/06/04/1290854/-Democrats-to-amp-up-calls-for-Medicaid-expansion-in-nbsp-campaigns
I Have Seen The Future, And It Is Medicaid - Paul Krugman: http://krugman.blogs.nytimes.com/2013/09/21/i-have-seen-the-future-and-it-is-medicaid/?_php=true&_type=blogs&_r=0
Physician Appointment Wait Times and Medicaid and Medicare Acceptance Rates: http://www.merritthawkins.com/uploadedFiles/MerrittHawkings/Surveys/mha2014waitsurvPDF.pdf
Democrats Tout Medicaid Expansion In Campaigns: http://www.kaiserhealthnews.org/Daily-Reports/2014/June/04/medicaid-expansion.aspx
2012: States Cutting Medicaid: http://www.kaiserhealthnews.org/stories/2012/july/25/medicaid-cuts-chart.aspx
Medicaid surge triggers cost concerns for states: http://www.foxnews.com/politics/2014/05/26/medicaid-surge-triggers-cost-concerns-for-states-101039544/
California Cuts Medicaid Payments Amid Wave of New Users: http://www.bloomberg.com/news/2013-10-04/california-cuts-medicaid-payments-amid-wave-of-new-users.html
New Study: Expanding Medicaid Reduces Access to Health Care: http://www.forbes.com/sites/aroy/2012/03/10/new-study-expanding-medicaid-reduces-access-to-health-care/
Sunday, January 19, 2014
Medicaid Fraud and You
From its inception, Medicaid is a program that was intended to provide medical care to those who are either at or below the national poverty thresholds. So, one would think that, if there are 46.5 million people in poverty in America in 2012, there would be about 46.5 million in the Medicaid program in that same year. Instead, Medicaid enrollment hit a record 72.6 million in that same year; or, a whopping 59% more people on Medicaid than in poverty.
While it's true that some states have expanded their Medicaid programs beyond the Federal guidelines for poverty, those states certainly haven't done so by a factor of 59%. The reason being that Medicaid is the second highest expense behind education. Therefore, the states can't just wildly expand the program without completely blowing their budgets.
The true fact is that Medicaid is ripe with fraud. Not only do some enrollees use fraudulent income data to enter the system; it is also a system that is weak in verifying when persons are no longer eligible for this benefit. So, the rolls just keep on growing. Even if the number of those in poverty starts to decline.
Obviously, any state or federal taxpayer is a big loser because this fraud is being primarily funded by state taxes with dollar-for-dollar, matching federal funds. Beyond that, there is a vicious circle that is being created that, not only hurts any person with private insurance (whether purchased alone or through an employer) but, actually, hurts those who are legitimately in need of Medicaid.
Because Medicaid is such a big and fast growing expense, states have opted to control costs by reducing the amounts they reimburse the health care providers. At the same time, the federal government has, too, reduced its reimbursements for care under Medicare. This, in turn, has resulted in those same health care providers charging private insurers higher and higher rates in order to offset the losses incurred in caring for Medicaid/Medicare patients. This fact is well borne out by the following chart:
So, not only does the average American pay higher taxes because of Medicaid fraud; their cost of health insurance is also going up. But, sadly, the "true" Medicaid patients are also being hurt in the process. That's because whenever reimbursements are reduced, fewer doctors and hospitals, especially the good ones, will accept these patients. The result is simple: Less quality of care for people on Medicaid.
Under ObamaCare, the already-broken Medicaid is being expanded by another 33%. That will only result in more fraud, higher taxes and/or reduced reimbursements, higher private insurance rates, and lower quality of care for the true needy of this country. This is just another reason why ObamaCare is so wrong for America.
References:
46.5 Million In Poverty: http://www.huffingtonpost.com/2013/09/17/poverty-america-census_n_3940812.html
Record 72.6 million on Medicaid: http://cnsnews.com/news/article/72600000-record-number-medicaid-2012-outnumbers-populations-france-and-uk
California Cuts Medicaid Reimbursements by 10%: http://www.bloomberg.com/news/2013-10-04/california-cuts-medicaid-payments-amid-wave-of-new-users.html
Census Bureau: Income, Poverty and Health Insurance Coverage in 2012: http://www.census.gov/newsroom/releases/archives/income_wealth/cb13-165.html
While it's true that some states have expanded their Medicaid programs beyond the Federal guidelines for poverty, those states certainly haven't done so by a factor of 59%. The reason being that Medicaid is the second highest expense behind education. Therefore, the states can't just wildly expand the program without completely blowing their budgets.
The true fact is that Medicaid is ripe with fraud. Not only do some enrollees use fraudulent income data to enter the system; it is also a system that is weak in verifying when persons are no longer eligible for this benefit. So, the rolls just keep on growing. Even if the number of those in poverty starts to decline.
Obviously, any state or federal taxpayer is a big loser because this fraud is being primarily funded by state taxes with dollar-for-dollar, matching federal funds. Beyond that, there is a vicious circle that is being created that, not only hurts any person with private insurance (whether purchased alone or through an employer) but, actually, hurts those who are legitimately in need of Medicaid.
Because Medicaid is such a big and fast growing expense, states have opted to control costs by reducing the amounts they reimburse the health care providers. At the same time, the federal government has, too, reduced its reimbursements for care under Medicare. This, in turn, has resulted in those same health care providers charging private insurers higher and higher rates in order to offset the losses incurred in caring for Medicaid/Medicare patients. This fact is well borne out by the following chart:
So, not only does the average American pay higher taxes because of Medicaid fraud; their cost of health insurance is also going up. But, sadly, the "true" Medicaid patients are also being hurt in the process. That's because whenever reimbursements are reduced, fewer doctors and hospitals, especially the good ones, will accept these patients. The result is simple: Less quality of care for people on Medicaid.
Under ObamaCare, the already-broken Medicaid is being expanded by another 33%. That will only result in more fraud, higher taxes and/or reduced reimbursements, higher private insurance rates, and lower quality of care for the true needy of this country. This is just another reason why ObamaCare is so wrong for America.
References:
46.5 Million In Poverty: http://www.huffingtonpost.com/2013/09/17/poverty-america-census_n_3940812.html
Record 72.6 million on Medicaid: http://cnsnews.com/news/article/72600000-record-number-medicaid-2012-outnumbers-populations-france-and-uk
California Cuts Medicaid Reimbursements by 10%: http://www.bloomberg.com/news/2013-10-04/california-cuts-medicaid-payments-amid-wave-of-new-users.html
Census Bureau: Income, Poverty and Health Insurance Coverage in 2012: http://www.census.gov/newsroom/releases/archives/income_wealth/cb13-165.html
Saturday, December 15, 2012
The Left's Latest Distortion: Average Salaries Are Higher In Non-Right-To-Work States
Ever since Michigan's legislature voted to make that state a right-to-work state, the political left has gone into full battle mode to prove that Michigan will actually be hurt by that decision. In one such attempt, a liberal economics group, The Economic Policy Institute (EPI), has released a position paper -- ‘Right to work’ The wrong answer for Michigan’s economy -- that explains just how bad that decision was. One of the key elements of that opinion is the fact that average incomes in the right-to-work states were lower by $1500 a year; even after taking into consideration the differences in the costs of living. And, for sure, that fact is being repeated by every Democratic politician and commentator who has appeared on TV or radio to discuss the Michigan decision.
In coming to that conclusion, the EPI ignores the fact that many of those right-to-work states have large rural populations that pay lower wages. As I have always said, you can manipulate statistics to prove any point, and that's exactly the case here. So, to be "fairer", I would prefer to look at two of our largest states -- California and Texas. California is definitely "not" a right-to-work state with a union workforce participation rate at 17.1%. Texas, on the other hand, is a right-to-work state with the union workforce population at about 5.2%.
Now, if you just superficially look at average incomes, California wins hands down. The average Californian's salary is about $61,632 and the average Texan only makes about $50,920 a year, but, even though Californians make 21% more than their Texas counterparts, Californians are actually a lot poorer. That's because the cost of things is almost 52% higher when you consider the cost of living index in California is at 135 and only 89 for Texas. So, when adjusted for these differentials, Texans are actually making the California equivalent salary of $77,938. Couple this fact with the fact that the unemployment rate in California is 10.1% and only 6.6% and you can understand why so many Californians are moving out of California to go to Texas.
One last thing. One of the primary drivers that makes California's cost of living so high is its high rates of taxation. Interestingly, those high taxes are primarily due to the state's higher-than-normal costs of paying its unionized state workers and their ever-growing pension and health benefits. Obviously, state workers are living high off the backs of the private sector workers. Certainly something that the left intentionally leaves out when comparing right-to-work states with pro-union states.
Additional References:
--- Bureau of Labor Statistics: Unemployment Rate By State: http://www.bls.gov/web/laus/laumstrk.htm
--- NBC Los Angeles: California's Population Is Moving Out, Census Report Shows: http://www.nbclosangeles.com/news/local/Californias-Population-Moving-Out-182914961.html
In coming to that conclusion, the EPI ignores the fact that many of those right-to-work states have large rural populations that pay lower wages. As I have always said, you can manipulate statistics to prove any point, and that's exactly the case here. So, to be "fairer", I would prefer to look at two of our largest states -- California and Texas. California is definitely "not" a right-to-work state with a union workforce participation rate at 17.1%. Texas, on the other hand, is a right-to-work state with the union workforce population at about 5.2%.
Now, if you just superficially look at average incomes, California wins hands down. The average Californian's salary is about $61,632 and the average Texan only makes about $50,920 a year, but, even though Californians make 21% more than their Texas counterparts, Californians are actually a lot poorer. That's because the cost of things is almost 52% higher when you consider the cost of living index in California is at 135 and only 89 for Texas. So, when adjusted for these differentials, Texans are actually making the California equivalent salary of $77,938. Couple this fact with the fact that the unemployment rate in California is 10.1% and only 6.6% and you can understand why so many Californians are moving out of California to go to Texas.
One last thing. One of the primary drivers that makes California's cost of living so high is its high rates of taxation. Interestingly, those high taxes are primarily due to the state's higher-than-normal costs of paying its unionized state workers and their ever-growing pension and health benefits. Obviously, state workers are living high off the backs of the private sector workers. Certainly something that the left intentionally leaves out when comparing right-to-work states with pro-union states.
Additional References:
--- Bureau of Labor Statistics: Unemployment Rate By State: http://www.bls.gov/web/laus/laumstrk.htm
--- NBC Los Angeles: California's Population Is Moving Out, Census Report Shows: http://www.nbclosangeles.com/news/local/Californias-Population-Moving-Out-182914961.html
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