Preventative stuff like physicals is still free on HDHP.
I have successfully negotiated a cash rate in the past for NCS, but not all call.
Medicare handles this with annual wellness visits by making you eligible on the first of the 12th month after the previous one. So if you had it done Dec 27th 2023, you would be eligible for your 2024 AWV starting December 1st 2024.
I work in medical economics. This f*cked up system keeps me and many others employed.
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Brown med school hasn’t gotten the memo, still recruits doctors more on DEI than medical skills.
Pass on any recent Brown grad doctor.
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Specifically a non-white-maile Brown grad, but they may have also been infected, so probably good to pass on them, too.
I recently declined a gas-passer who interned in the Vandy children’s hospital. They were indoctrinated, early on, to accept money over common sense. My surgeon wasn’t happy, but I explained my objection, providing minimal evidence, and since I was paying the bill, he didn’t squawk too much. I also offered a lot more evidence of my objection.
The latest crop of DEI medical graduates aren’t up to par, and you’ll be suffering when they operate badly on you.
The American College of Surgeons continues to push DEI initiatives, ignoring or censoring anyone who disagrees. For example, ACS has implemented remedial training for graduate surgeons through “mentorship” programs. One challenge: finding enough experienced surgeons of the correct ethnic, racial, or gender identity to serve as mentors.
A surgeon who successfully completed a full residency was once expected to practice independently without supervision. Increasingly, this is no longer the case. I worry for the future of my profession—and even for myself, on the day that I enter the world of surgery as a patient.
You can only find old school surgeons and doctors for so long before they’re too old and not available.
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Medicaid ripe for DOGE style cuts
since 2013, the number of Americans living in poverty has fallen by by 10 million. Yet during that time Medicaid’s monthly enrollment has leaped from 54 million to 79 million, and its inflation-adjusted federal cost has nearly doubled from $351 billion to $643 billion. Opportunities for savings certainly exist.
An easy place to save up to $160 billion over the decade would be repealing a Biden administration rulethat limited how often states may verify the eligibility of their Medicaid recipients.
Essentially this rule forced states and the federal government to continue providing benefits to families whose income has risen high enough to graduate out of this anti-poverty program.
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That certainly sounds auspicious…
Since a majority of people voted for this, I’m sure it’ll be fine. At least for me since I’m not impacted.
They also eliminated asset tests. Now, you can be asset rich yet income poor, and qualify for Medicaid. I’d dare say that this is more of a factor to the enrollment growth than limits on recertification. Before, a family with mere high 4-figures in savings was not eligible regardless of how little they earned. Now they can have multiple millions in the bank, and as long as the income from that savings is deferred or otherwise sheltered, they can still qualify for medicaid.
Heck, I’d bet that the costs of processing recertifications more frequently will far exceed the savings from purging people who are no longer eligible a few months sooner.
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Probably not people sitting on multiple millions who will settle for Medicaid.
But 3 years ago, I helped a relative plan their taxes qualify for it. Used a combination of strategic withdrawals from taxable account, previous year HSA expenses, and Roth distributions to have just enough taxable income to qualify for it despite pulling $100k/yr or so from various accounts. For 2-3 years until they reached Medicare age.
I was thinking the exact same. If States need to constantly check for recertifications, that will not be a cost-free process. Hopefully it’ll save enough to pay for itself and start changing behaviors around trying to stay on these programs as long as some people do.
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Maybe not in certain major metro areas where doctors are more selective about choosing to accept Medicaid. In many less urban areas, Medicaid is accepted as ubiquituosly as any other insurance, so “the best” doctors are just as available as with any other coverage. For the most part, Medicaid is the true cadillac health insurance option for a typical person/family, unless you have very specialized health needs that fall into a random gap in coverage.
And besides, the point is that the asset threshold was very low. You didnt need to have anything close to millions, having a couple thousand dollars made you ineligible.
Sounds like Medicaid became a form of “Medicare for all”.
It feels to me like the current policy is too permissive and the old one too strict. It depends on where we want to put the bar on government assistance for health care. ACA lowered the bar a ton by being based on a household MAGI. Wouldn’t make any sense to make qualification for Medicaid more difficult than for ACA subsidies (or at least both need to be changed simultaneously).
I wouldn’t say “for all”. If you don’t have Roth or HSA accounts, or large amounts of savings you’re willing to deplete, it’d be challenging. For my relative, it was not sustainable forever to make their income appear to be this low while effectively supporting a lifestyle consuming 3 times as much.
But that’s exactly the risk of relying on MAGI only for eligibility without any kind of assets testing. In a way, the qualification for need-based financial aid for college students is more robust than Medicaid or ACA.
Medicaid is deing abused by Democrat run states like California. The 700,000 illegal aliens is a WAG and is probably much larger. This article is from Dec 2023
California will welcome the new year by becoming the first state to offer health insurance for all undocumented immigrants.
Starting Jan. 1, all undocumented immigrants, regardless of age, will qualify for Medi-Cal, California’s version of the federal Medicaid program for people with low incomes.
The final expansion going into effect Jan. 1 will make approximately 700,000 undocumented residents between ages 26 and 49 eligible for full coverage, according to California State Sen. María Elena Durazo.
The state share of Medicaid in California is nearly $10 billion a year
Guadalupe Manriquez, the California Department of Finance program budget manager, told the state Assembly Budget Committee Monday the state is “spending $9.5 billion total funds” to “cover undocumented individuals in Medi-Cal” in the current year.
None of the articles or quotes you provided allege that anything is being abused. Or illegal, improper, unethical, etc.
So you approve of your tax money being used to pay for medical care for people who are breaking the law? The Democrat run states are exploiting a loop hole the Medicaid law that the Republican majorities in Congress will hopefully soon close.
See this article from early 2024
“Liberal states, like California, have abused loopholes to provide Medicaid to illegal immigrants at the expense of hardworking taxpayers. Not only is this against the law, but it further incentivizes more illegal crossings at our border,” Hudson said in a statement to the DCNF.
“Worse, it puts citizens who truly depend on the program on the backburner. This common sense bill will help protect Americans’ tax dollars from being used to subsidize illegal immigrants’ healthcare costs and ensure that the most vulnerable among us can get the care they need,” Hudson added.
Federal funding can’t go towards Medicaid coverage for illegal immigrants, but the states choosing to provide healthcare have used state funding for their programs.
The House bill would require the Inspector General’s office at the Department of Health and Human Services (HHS) to review states’ actions and submit a report to Congress regarding the funding of healthcare for illegal immigrants.
“The actions taken by California and other states can significantly shift the Medicaid cost burden onto the federal government and threaten access to care for other vulnerable populations. House Republicans must pass this legislation to stop the flow of illegal immigrants at our border and not let the American taxpayers foot the bill for California’s and other blue state’s outrageous decisions,” Guthrie said in a statement to the DCNF.
Republican Louisiana Sen. Bill Cassidy introduced an accompanying bill on Jan. 11 in the Senate to address the issue.
The problem is that my tax money is being used to pay for medical care of those people with or without this program. People who have access to insurance will use it to see a doctor. People who don’t have insurance wait until they end up in the emergency room, which costs a lot more. I’d rather they stay out of ER.
Also I don’t think it’s against any law. The states get to decide how to administer Medicaid. And as your quote mentions, the states that do this use state funding for these programs, not federal.
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That’s only true if you assume free medical care in CA doesn’t incentivize additional illegal immigration compared to who was already here.
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Shouldn’t this be left to each State to decide what to spend their Medicaid money on? California is one of the States receiving the least amount of Federal aid per capita.
IMO we should just even out the level of Federal aid per capita (citizens and permanent residents only) in each State and leave each State to decide what they do with that money. If California voters want to use Federal aid to pay for illegal immigrant healthcare, leaving them to shoulder more of the burden for healthcare of low-income legal residents via higher state taxes, maybe it should be their right.
Or leave this entirely to States by replacing Medicaid entirely by a state-funded only system in which each State controls the level of taxation and how to use the tax dollars. That would be my preferred choice.