Implications of Mass. Health Insurance Law

[Martha]

The other great thing Clinton allowed was time limitations for collecting welfare. But what happened was everyone jumped to SSI - when welfare ran out - by claiming a mental disability. So we still have some work/regulation ahead of us (if we deem these programs necessary).

You have numbers? I don't think so. I used to do social security disability and SSI appeals for legal aid when I was in law school. It is tough to get covered uder those programs. And, you get re-evaluated frequently.

Are these programs necessary? I hope you aren't serious. I know child who is autistic and at nine years old, still has not learned to use a toilet. He will be a success if he gets potty trained. He calls me aunty same because I look just like my sister. We were all thrilled when he recognized me as a separate person.

One of my husband's former tenants has regular serious grand mal seizures even on pills, which are destroying his liver. Not only does he have no end of physical problems, but he is mentally retarded.

He had another tenant that ended up in assisted living. Severe arthritis since a child, can hardly move. His hips have degenerated to nothing. His parents retired at 65, are now about 70 and are trying to be retired. They had him move into my husband's building so he could get used to being without them. They are worried what will happen to him when they die.

Then there is the couple who were also my husband's tenants. She has Down Syndrome and he is quite slow. Both are on SSI. They don't marry because the SSI would be seriously reduced. She loves her dolls and stuffed animals. She thinks Greg is the funniest guy in the world. (She's right) She goes to a day program. Her boyfriend works at Goodwill moving stuff around. He loves to work and loves his job. However, he must be under heavy supervision and given repeated instructions.

These tenants would have their spats with each other from time to time. Just like here. Greg sometimes would have to intervene. They often would run to him to resolve their personal problems. He was the kind uncle in their lives. He still is, even though he is no longer their landlord.

Then there is my autistic brother. He is on SSI too and lives in a subsidized apartment. Once in a while he has a job, generally nighttime cleaning. These jobs don't last long--many autistic adults have no ability to read people. He has a hard time managing his money and there is not quite enough for him and his cat. I subsidize the cat. He also smokes. I am sure you guys dislike the idea of someone on SSI smoking. After all, its your money.

 

[Maximillion]

My Personal Experiance with the US System was a lady I knew whose Husband died from Cancer, the Bills were more than the insurance would pay, she was forced to sell her house .

She now lives with her Daughter.

I also had a Friend who had difficulty getting a job due to his diabetes as Companies did not want to pay the premiums for his insurance.

A Surgeon friend just returned from the States , he said he got fed up fighting with HMO's, not getting paid, always being challenged. Here, 100% payment, automatic.

 

[youbet]

A Surgeon friend just returned from the States , he said he got fed up fighting with HMO's, not getting paid, always being challenged. Here, 100% payment, automatic.

Don't blame him for going back.  What could he have been thinking when he left the absolutely perfect Canadian system to practice in the dismal medical system of the States?  Perhaps he was a little wacko?

 

[cute fuzzy bunny]

You got a better set of responses than I did Al, for what thats worth.

There are plenty of good reasons for a nationalization (or nationalization within states, which is what I figured would happen). I'm figuring a quarter of what we're paying for health care is wasted forms and horsepuckey. I'm not getting proactive care, I get a pill when I report a problem. Then the insurance overpays for the pills indefinitely. If you cant afford to pay for health care, then if you get sick you're supposed to just lay down and die?

As far as not wanting the emergency rooms to provide basic stabilization, hope to god the next time you get hurt you've got your insurance card on ya...

 

[kramer]

You are not eligible for MediCal based on income alone.


People in many different situations qualify for Medi-Cal. They are listed below.

This is correct, there is an application procedure for those who don't automatically qualify. My uncle was one of these and, as I mentioned in my post, he had to go through this procedure. I have never heard of someone getting rejected, but that doesn't really mean anything without statistics. The people that are in trouble are folks with a job above 3x poverty level or so and who get sick without insurance. They will be paying list prices (e.g., ripoff prices). You can typically negotiate this down by around 25% or so, but that means you are still paying 3x what an insurance company pays.

I agree with Martha that it is difficult to get on SSI. It requires, I believe, 100% disability and the payments are not large, in any case. That being said, yet another relative of mine got on SSI just last year And in my opinion, she is lazy and does not want to work as I know the details of her case and I could not believe that she got a doctor to sign off -- although there is some mental disability there, she can work, IMO, and I know how lazy she has always been. But it was a lot of work on her part to get on the program -- as hard as a part-time job that she should have been doing. I do NOT think this is typical of most SSI recipients. It is an important program.

I have another relative who gets 90K per year, part of it tax free, from a private medical disability policy. He spent the last three years rebuilding his house, almost entirely on his own, from single story 1200 square feet to over 4000 square feet and three stories (he did everything himself including electrical, plumbing, roofing, flooring, drywall, etc.). He remodeled the kitchen, every bathroom, all of the original rooms, etc. For every dollar he earns on a regular job, his disability policy pays one dollar less. So instead he turned his labors to his home, which is not covered by this scheme, and his home value has gone from $600K to almost $2 Million with his renovations (part of this is appreciation, but not most of it, the old house would be worth well under a million). This is a private disability policy paid by two separate insurance companies. I have a very eclectic family. I am not making this stuff up

Kramer

 

[Maximillion]

Limit Law Suits, frivolous cases should be dismissed.

If a Straw cost a $, charge the patient a $, NOT $5.

Many of the tests carried out in US Hospitals are for no reason other than a potential piece of evidence in a legal action.

US Citizens need to accept the concept of wait times, nothing wrong with waiting a few months for a Hip Replacement, you may be uncomfortable but you won't die.

Establish Centres of Excellence, dedicated Hospitals that may perform Cardiac, Neuro etc, reduce Marketing Competition.

Hospitals Buy and Brag about equpment, then never use it.Lasers were bought like crazy by Hopitals so the could advertise the NEW Laser surgery for Lap Choly, 99% of the Lasers were never used, a $4,000 Cautery did the job as well and the Hospitals already had dozens of them.

Surgery as a LAST RESORT, focus on prevention, abuse counselling whther drugs, booze, or weight, start at them while they are young, focus on exercise, cut out fast foods, get Coke out of the Cafeteria, Parents set an example.

 

[tryan]

You have numbers?  I don't think so.

Best I can see from the graph (linked below) ~25,000 people jumped to SSI once welfare reform kicked in.  This is roughly a 50% increase in disability SSI payments.

First we need to understand welfare reform work requirements:

Making Welfare a Transition to Work

Work requirements. Under the new law, recipients must work after two years on assistance, with few exceptions. Twenty-five percent of all families in each state must be engaged in work activities or have left the rolls in fiscal year (FY) 1997, rising to 50 percent in FY 2002. Single parents must participate for at least 20 hours per week the first year, increasing to at least 30 hours per week by FY 2000. Two-parent families must work 35 hours per week by July 1, 1997.

http://www.acf.dhhs.gov/programs/ofa/prwora96.htm

... so its a phased in approach from 1997-2002 (exact details vary from state to state but if the state wants federal $$ they need to move people OFF welfare).

Now the SSI roles ... best seen in the attached link.  Note the gradual skew upward from ~50,000 disabled collecting SSI (1999) to today's rate ~75,000.  An increase of ~25,000 or 50%.

http://www.ssa.gov/OACT/ProgData/awardGraph.html

Yes, we need a safty net for the most vulnerable in our society. But this data shows that for every 2 we help we hurt 1 (via dependency).

 

[Martha]

You are reading a lot into the graff. First, the graff linked to was for social security disability--not SSI. To be eligible for SSD you need to have a certain number of credits from work, generally 40 credits. You also must be totally disabled for at least a year. Aging population? Correlation isn't necessarily cause and effect.

Note the doubling of people awarded SSD between 1984 and 1994.

Also, we don't know if some who were collecting AFDC were in fact disabled.

From my experience in doing SSD and SSI appeals, the federal government has long made it its job to question eligilibity for these programs.

This graff doesn't show that for every two we help, one we hurt.

 

[Brat]

I have a middle aged nephew on Medicaid-SSI, he has a serious mental illness.  As much as he says he wants to work, he hasn't held a job more than a week or two (was fired by Goodwill!).  Frankly, I wouldn't hire him either as he has no insight and is very demanding.

In my youth people with serious mental illnesses were in institutions.  Now the lucky ones receive medicaid-SSI and are in community housing.  The others are often found sleeping on the streets or in the alternative mental health institutions - prisons.

 

[Martha]

Best I can see from the graph (linked below) ~25,000 people jumped to SSI once welfare reform kicked in. This is roughly a 50% increase in disability SSI payments.

First we need to understand welfare reform work requirements:

http://www.acf.dhhs.gov/programs/ofa/prwora96.htm

... so its a phased in approach from 1997-2002 (exact details vary from state to state but if the state wants federal $$ they need to move people OFF welfare).

Now the SSI roles ... best seen in the attached link. Note the gradual skew upward from ~50,000 disabled collecting SSI (1999) to today's rate ~75,000. An increase of ~25,000 or 50%.

http://www.ssa.gov/OACT/ProgData/awardGraph.html

Yes, we need a safty net for the most vulnerable in our society. But this data shows that for every 2 we help we hurt 1 (via dependency).

From 1996 through 2001, SSI caseloads and expenditures rose less than 2%. http://www.frbsf.org/publications/economics/papers/2002/wp02-20bk.pdf

 

[tryan]

You are reading a lot into the graff.  First, the graff linked to was for social security disability--not SSI. 

We're splitting hairs here, aren't we ... no distinction made on the checks; maybe the $$ comes from the same place.

To be eligible for SSD you need to have a certain number of credits from work, generally 40 credits.

This is good ... credits come pretty easy though (1 per $970 wages).

  You also must be totally disabled for at least a year.

And the application process can take just as long.

From 1996 through 2001, SSI caseloads and expenditures rose less than 2%. 

hmmm ... little too early to tell.  Real reform didn't take hold until 2002 and with a lenghtly application process... We'll have to wait for updated data.

In the mean time I have one tenant who recently told me she "can't work anymore".  I'll ask her about the process from the front line.  5 years ago I would have had 1/2 a dozen to interview ... now I only have a few units left (less data from the front line).

 

[Martha]

We're splitting hairs here, aren't we ... no distinction made on the checks; maybe the $$ comes from the same place.

No, your information was on SSD, not SSI. Different pots.

This is good ... credits come pretty easy though (1 per $970 wages).

With a max of 4 credits a year. Ten years of working to get 40 credits. You will have to be pretty clever to work in little bits to accumulate 40 credits.

So, SSI ranks have not increased in any significant amount for a number of years, though we only have data through 2001. Only 2.5% of people were on SSI for drug and alchohol additon, before they were removed in 1997. SSD has had increases since 2000, but we don't know why and it had large increases in the past as well. We also don't know if a number of people who were on AFDC went to SSI because they were in fact disabled. We also do not have any facts which would support that people are improperly entering the SSD and SSI roles as disabled when they are not.

I still talk to lawyers at legal aid who do SSI/SSD appeals. These say it isn't any easier than when I did the appeals.

 

[tryan]

We also do not have any facts which would support that people are improperly entering the SSD and SSI roles as disabled when they are not.

... except the able bodied tenants I had who magically started collecting after thier welfare timed out. And the numerous applicants who giggled or twirled thier finger around the side of thier head when I asked why they're collecting SSI - maybe it was SSD, but they always said "SSI".

I am wondering if a wheel chair ramp is needed ... thier laughing like it's the next best thing to an ATM.

I'll talk to some of current tenants an ask thier opinion of how hard SS? is to collect.

 

[cute fuzzy bunny]

Seems to me theres a big difference between documents based on thousands of pieces of information and a few pieces of anecdotal evidence.

 

[REWahoo]

Seems to me theres a big difference between documents based on thousands of pieces of information and a few pieces of anecdotal evidence.

You mean like the govt. collecting job growth information from thousands of sources vs. your personal observation of what's happening in Yuba City?

(Sorry, couldn't resist. I know you will set me straight. )

 

[LOL!]

I have not investigated the terms of the Mass Health Insurance Law, but I have a question:

What is to prevent folks from moving to MA just to take advantage of this law? If health insurance is guaranteed to everyone in the state and is significantly less expensive than in other states, why wouldn't the chronically ill move to Massachusetts?

 

[tryan]

why wouldn't the chronically ill move to Massachusetts?

Exactly what we're setting ourselves up for ... just like when Gov. Dukakis relaxed wefare laws to give bennies to illegal aliens. The result is/was predictable.

 

[Brat]

If health insurance is guaranteed to everyone in the state and is significantly less expensive than in other states, why wouldn't the chronically ill move to Massachusetts?

Their weather and housing costs, for two things.  What you save in health insurance may be eaten up by housing and heating bills.

Many chronically ill are dependent on family members to help them.  While some might be despirate enough to move I don't think there will be massive migration.

 

[Maximillion]

Alberta is a Canadian Province that has ammassed so much money from Oil exports that they have given everyone $400 tax Free, and are talking of eliminating Provincial Income Taxes, except the concern people would move there.

The weather, the cost of housing, the lack of a social net work would prevail against that, just like Massachussets.

6 Month waiting time is an alternative.

 

[Martha]

Tryan, more information on what happed to those cut from SSI who were on as drug and alcohol addicts:

http://www.npc.umich.edu/publications/policy_briefs/brief4/

By the end of 1997, the DA&A (drug and alcohol) caseload as such had ceased to exist. By April 1999, only 35.5% of former DA&A recipients had requalified for SSI under other medical conditions, most often a psychiatric disorder.

Evidence on how former beneficiaries are faring is limited. A multi-site longitudinal study of former DA&A recipients found that employment (defined as having any reported income from employment in the six months before the interview) increased from 20% to between 40 and 60% for those who did not requalify for benefits. However, the additional earnings were not large enough to offset the lost benefits for a majority of former recipients. Less than 25% of former recipients reported earnings of $500 per month or more (the approximate loss in SSI beneftits). In spite of this decrease in income, this study did not find widespread negative effects on those who no longer received benefits, as the majority did not report problems with lack of housing or increased hunger. However, the study sample used was quite dissimilar from the national DA&A population.



So only 35.5% of the DA & A population (which was only 2.5% of the SSI roles) ended up back on SSI due to other disabilities. Of the nearly 2/3 that were cut off that weren't otherwise eligible for SSI, most of those who found work ended up earning very little.

 

[Martha]

Their weather and housing costs, for two things. What you save in health insurance may be eaten up by housing and heating bills.

Many chronically ill are dependent on family members to help them. While some might be despirate enough to move I don't think there will be massive migration.

My hunch is that you are right. And people also don't know what other states offer. And people may simply want to stay home.

 

[2B]

Now what I want to know is if I move to Cape Cod for the fishing in the 3 months that pass for summer will I still be able for free heath care.  I can make sure I won't have any money outside of IRAs which are exempt from most things.

On the other 9 months I can drift south as the fishing opens up.

Is that a strategy for a non-contributor the Mass. society?  Actually, I will contribute a little to the local grocery and liquor stores.

 

[cute fuzzy bunny]

You mean like the govt. collecting job growth information from thousands of sources vs. your personal observation of what's happening in Yuba City?

(Sorry, couldn't resist. I know you will set me straight. )

I knew someone would bite on that. Its an easy set though. If the govt actually collected the job growth information from thousands of sources that'd be swell. But they make up half of it based on other numbers that are similarly estimated or extrapolated.

Which makes it bullshit.

 

[Maximillion]

I shake my head that it is even an issue with the wealthiest country in the World, again, Bayer or Boeing, Iraq or Indiana,it ain't rocket Science.

1,2 3 what are we marching for?

 

[samclem]

Maybe it got to be the wealthiest country be eschewing collectivism.