Jackson Free Press

The Mississippi Department of Medicaid's high estimates of what the federal health-care legislation will cost the state are overstated, Mississippi Health Advocacy Program Director Roy Mitchell said today.

Yesterday, during a budget presentation to a joint legislative committee, Mississippi Medicaid Executive Director Robert Robinson said the Patient Protection and Affordable Care Act will cost the state between $225 to $250 million a year because the federal government neglected to factor in administrative costs and the cost to cover children.

Because the bill expands eligibility for Medicaid, Robinson reported that it would put 88,990 more Mississippi children on government-funded health insurance, and 140,948 adults and pregnant women between 2011 and 2014.

"(Robinson's) numbers make no mention of the fact that the federal government is paying the cost of most of these increases," Mitchell said, pointing out that the federal government is paying for 100 percent of costs for covering newly eligible individuals through 2016. The federal government's reimbursement rate to states falls to 95 percent in 2017, and 90 percent coverage after 2019.

Medicaid officials also expect children qualifying for the federally-matched Children's Health Insurance Program to increase by 840 kids, newly qualifying childless adults who make up to 33 percent above the federal poverty level ($29,327 for a family of four) will put 188,000 new beneficiaries upon Medicaid when they qualify in 2014.

Rep. George Flaggs, D-Vicksburg, said he found Robinson's estimates staggering.

"If I didn't know better I would conclude that Mississippi is going to be the poorest state in the third world, because that means we're not about to offer normal wages, no betterment of social living conditions, or nothing," Flaggs said. "We have 699,000 people on Medicaid now, and we're about to have another governor and another legislature. If by 2014 we've got that many people still on Medicaid then we need to be run out of this country. We're not doing anything (to help) with the socioeconomic status of our people."

"If that projection is true, then I might as well join the Tea Party tomorrow," Flaggs added.

Republicans at the table emitted a volley of chuckles at his statement and invited him to "come on over" to the Tea Party.

Rep. Diane Peranich, D-Pass Christian, jokingly referenced a 1999 statement from Republican Delaware Senate nominee and Tea Party advocate Christine O'Donnell, and warned Flaggs that he would have to "first dabble in witchcraft," to qualify for Tea Party status--which abruptly ended Republican laughter, but sparked new laughter among Democrats in the room.

Division of Medicaid Administrative Deputy Lynda Dutton said her office expects up to a $1.7 billion increase in state Medicaid expenditures, triggered by factors such as administrative costs related to reform for 2014.

But Martha King, director of the National Conference of State Legislatures' health program, pointed out that unless the federal law changes, the federal government will continue to cover 90 percent of costs for newly eligible beneficiaries after 2014.

"The state's federal Medicaid match is already 84.86 cents on the dollar, the highest in the nation when including some American Recovery and Reinvestment Act funds," King added.

Previous Comments

ID

159953

Comment

Adam, the source of our numbers is our contracted nationally recognized accounting firm that did a projection using all possible factual variables. I really am not interested in the politics of the federal initiatives that use a bait, hook, and switch, technique to get states on the hook for program costs when their "reimbursements go away. HELLO, that's why of the $200 million more the Division needs for this year's budget, $152 million is to make up for federal funding that has vanished. What a surprise! This is America and you can choose to believe Medicaid officials who have immersed themselves in the verification of these numbers, or you can believe those who feel they know more about this complex program because of whatever (popularized) reason they put forth. Francis Rullan Communications Director Division of Medicaid

Author

Francis Rullan

Date

2010-09-23T14:04:30-06:00

ID

159961

Comment

I think the Division should make the accounting report public so that the taxpayers can examine it on merit or ask for a second opinion. Aren't those the reimbursements that were extraordinary items that came from ARRA?

Author

write2richie

Date

2010-09-23T14:54:23-06:00

ID

159962

Comment

Francis, thanks for commenting. I am confused about your post, however. According to Adam's story above: Martha King, director of the National Conference of State Legislatures' health program, pointed out that unless the federal law changes, the federal government will continue to cover 90 percent of costs for newly eligible beneficiaries after 2014. "The state's federal Medicaid match is already 84.86 cents on the dollar, the highest in the nation when including some American Recovery and Reinvestment Act funds," King added. Is that inaccurate, or is there something we're missing? Also, since you mentioned the accounting firm, I looked around a little and found out that Mississippi isn't the only state (with a Republican governor) that has used the firm, and it is coming under fire in other states for ... wait for it ... over-estimating how much health-care reform will increase Medicaid costs. Such as in this Associated Press report in Nebraska: New report: Neb.'s Medicaid costs overestimated It begins: LINCOLN, Neb. (AP) - A report commissioned by the state forecasting that federal health care reform will increase the state's Medicaid costs by hundreds of millions of dollars over the next decade was based on "an over-the-top assumption" and seriously flawed, a Medicaid expert said. The prediction of skyrocketing state costs overestimates the number of new Medicaid participants and the cost per enrollee, said Dr. Leighton Ku, a professor at the School of Public Health and Health Services at George Washington University and director of the Center for Health Policy Research. High-end estimates in the report by actuarial firm Milliman Inc. are based on the assumption that every Nebraska resident who is eligible will enroll in Medicaid _ a scenario Ku said is "just ridiculous and should be ignored." "No voluntary program ever experiences 100 percent participation; that is just an over-the-top assumption which can only lead to overestimates," he said.

Author

DonnaLadd

Date

2010-09-23T15:05:42-06:00

ID

159963

Comment

Here is another relevant article out of Washington this week about possible Republican scare tactics and overblown numbers (by Milliman) in Nebraska. The article links to a letter sent out by the governor, as well as reports. And the comments under the piece have more relevant links. And here is more on Nebraska's Milliman firestorm last week: Milliman Explains Assumptions and Methodology Used in Nebraska Medicaid Budget Exposure Analysis Would you be willing, as write2ritchie suggests, to make the accounting report public? That must be public record. Or is it already public?

Author

DonnaLadd

Date

2010-09-23T15:15:02-06:00

ID

159964

Comment

Certainly we can debate the veracity of our reports vs. the reports of others predicting the outcome of a healthcare initiative that has most American concerned, confused, and hopefully involved with the eventual outcome. Instead, may we look at the bigger picture? Certainly mercy supersedes law because laws are made by man and man is imperfect. Any social welfare position that introduces more complexity does not resolve the basic fact that poverty in Mississippi (and the United States) is on the rise. In fact, it has been on the rise for the past ten years I have served as the Director of Communications here at Medicaid. How then, can we continue to address this tragic reality in a way that decreases the suffering in the short run and lays groundwork for a stronger society, less dependent on others for the basic necessities of life?

Author

Francis Rullan

Date

2010-09-23T15:37:33-06:00

ID

159966

Comment

Any social welfare position that introduces more complexity does not resolve the basic fact that poverty in Mississippi (and the United States) is on the rise. Stipulated. But I'm not sure how that changes to need to figure out if Republicans are purposefully pushing overblown data to scare people into being against health-care reform. Why don't we talk specifics instead of nanny-state rhetoric?

Author

DonnaLadd

Date

2010-09-23T17:48:25-06:00

ID

159979

Comment

Republicans are doing everything they can to discredit and hold back any progress the Obama administration makes. Republican run states wrap stimulus funds in red tape or waste them on useless projects in order to claim they didn't work. Republicans fight a Small Business help bill for three months so they can take the credit for any improvements. Of course they are going to exaggerate any 'issues' with Health Insurance Reform. Most still use the big lie of "government takeover" - and propose to do a real Federal takeover of health insurance by forcing States out of the picture and allow purchasing health insurance across state lines - regardless of state laws. Looking at the big picture, it is my opinion that the Republicans are purposefully keeping our economy down, holding it hostage in order to take back over. I am afraid that if they do, they will finish U.S. off.

Author

BobbyKearan

Date

2010-09-24T13:56:00-06:00

ID

160006

Comment

Certainly mercy supersedes law because laws are made by man and man is imperfect.....How then, can we continue to address this tragic reality in a way that decreases the suffering in the short run and lays groundwork for a stronger society, less dependent on others for the basic necessities of life? In Mississippi we can be "merciful" in solving this problem by raising the state income tax on the higher income individuals and raising county taxes on the LARGE corporate agribusinesses. With our current tax structure the lower and middle income Mississippians are subsidizing the protection of the personal property, civil court protections, recreational services, etc, of the higher income Mississippians. A "merciful" definition of equitable taxation could be stated as: "Everyone should contribute to the protection, preservation and improvement of the general society (pay taxes) in direct proportion to the value of what they have to protect". This concept was similarly stated in the Old Testament and legislated during the Eisenhower administration when the maximum tax rate was around 90%. Of course you had to make a "lot of money" to be taxed at that rate.

Author

FrankMickens

Date

2010-09-26T08:37:52-06:00

ID

160054

Comment

FrankMickens - I agree - Got a question though... Why is it that most people don't point out - and I suppose many don't know - that tax brackets are stepped - meaning you pay the rate for each step of income. So if you make over $373,650 - you (couple) pay 28% on income from $137,300 to $209,250, 33% from $209,250 to $373,650 and then 35% ONLY on income over $373,650. So, its not like it is a 35% of ALL income to begin with. I would like to see more steps on the ladder. Up to maybe 50% on income from $10 million on up. And, I'd also like to point out that it is Taxable Income - meaning after all the deductions they can take out. Remember, 10% of the population pays 60% of the taxes - but control 90% of the wealth (percentages +/- 5% either way variable by year - look it up, its true!).

Author

BobbyKearan

Date

2010-09-27T19:43:01-06:00

ID

160062

Comment

That makes too much common sense. The current agenda in Washington is to create a means by which the difference between the "haves" and the "have nots" more mirrors the European model. That model would make more people easier to control by one central source, worldwide.

Author

Francis Rullan

Date

2010-09-28T07:13:31-06:00

ID

160067

Comment

"One central source, worldwide"? Mr. Rullan, are you speaking on behalf of the state and the governor in these comments? Just curious. On a slightly different topic, do you mind if I ask your salary? And how large of a communications staff does the Division of Medicaid have?

Author

DonnaLadd

Date

2010-09-28T07:52:06-06:00

ID

160088

Comment

That's correct Jason, just like the $152,110,277.00 we are in the hole for due to ARRA dollars going away. When you can name me a federal non-bait and switch social-welfare program that has not expanded past its original premise, I will be more willing to to debate the definition of real dollars vs. debt dollars pertaining to this issue with you. And for the record, I do not lie about anything, especially about issues such as this. So you understand, I am a first generation American from the old school, Bronx, New York City public housing project raised. Address me in a respectful tone or not at all. Understood? Thank you DoonaLadd for your question. My responses here are from a personal point of view. They come from being a professional newsman in a top 25 market and with 30 years experience in the communications business prior to my 10 years here at Medicaid. I do not speak for the Governor. He has a Public Relations Director that does that. I earn far less money than the State was paying an advertising agency to accomplish far less than what I do here and have accomplished here in the past 10 years. We have a staff of 2 with me included. Mississippin Medicaid has one of the lowest administrative costs in the United States.

Author

Francis Rullan

Date

2010-09-28T09:56:17-06:00

ID

160091

Comment

Mr. Rullan, we ask everyone to use a respectful tone here. And we also ask people to deal in specifics. Several of your comments seem to be more ideological and perhaps even anti-assistance in tone, which seems odd coming from someone in your position with the Division of Medicaid and someone who is paid by the taxpayers (you still didn't say how much). I was particularly struck by this statement: The current agenda in Washington is to create a means by which the difference between the "haves" and the "have nots" more mirrors the European model. That model would make more people easier to control by one central source, worldwide. This is not a statement that instills confidence that the governor has not stocked state government with anti-government ideologues. It sounds like the kind of statement one sees on wingnut conspiracy blogs. With due respect.

Author

DonnaLadd

Date

2010-09-28T10:13:56-06:00

ID

160092

Comment

Thank you for your comment DonnaLadd. It was well stated. My request for civility was not directed towards you. Again I do not speak for the Governor. For the record, I was hired under Governor Musgrove and have always been an independent thinker with my own opinions. I do speak from experience, some of which I gleaned when working as a medical segment producer/writer/director on a documentary (about 20 years ago) comparing British, Canadian and American medical models. Here at Mississippi Medicaid, I have been recognized as being "Employee of the Year" as well as having a model project in my Certified Public Manager's training. You may submit a public records request to learn my salary amount. I joined this organization to be of service in the communications aspect of this program and have been recognized by six executive directors for accomplishing that goal.

Author

Francis Rullan

Date

2010-09-28T10:32:49-06:00

ID

160093

Comment

You're welcome, Mr. Rullan. And congratulations on all your honors. I am always amazed when a public servant refuses to reveal their salary when requested. That puzzles me, especially from someone such as yourself who seems to hold such a distrust of government. Does that indicate that you prefer that the public not know how much the government pays you to speak on behalf of the Division of Medicaid? Do you mean that you are "speaking from experience" when you accuse the president of the United States of trying to "create a means" to "make more people easier to control by one central source, worldwide"? And for the record, I am no fan of Ronnie Musgrove, either, so that doesn't help you much in these parts. I don't throw or pull a punch due to partisanship.

Author

DonnaLadd

Date

2010-09-28T10:38:23-06:00

ID

160094

Comment

Also, wouldn't it save the taxpayers a few dollars to just tell us your state salary rather than force state staff to have to deal with an open-records request? It's not like it's stored in a warehouse somewhere.

Author

DonnaLadd

Date

2010-09-28T10:47:21-06:00

ID

160095

Comment

You shouldn't be amazed. We have so many regulation issues so I am always hesitant to release information prior to checking to see if it is permissible. I just received my answer, it is permissible. I earn $67,509.19 per year. What I meant by "speaking from experience" is that government run health insurance based on the European model (in my experience) has proven not to be as efficient and effective as our own. Using the President's own calculations, 10%-30% of social welfare healthcare funds are lost due to fraud. In our Mississippi Medicaid program that would amount to $500M to $1.5B per year. Clearly, we need to fix this before we enlarge this model! As to Governor Musgrove, he had his good points as have all the governors I have served under in one capacity or another (Finch, Winter, Mabus, Barbour) when working for our state over the years. I am a fan of this newspaper because it does not pull punches. I have not entered into a public discussion such as the one we are having now with anybody else.

Author

Francis Rullan

Date

2010-09-28T11:00:09-06:00

ID

160103

Comment

Is the Milliman report a public document?

Author

write2richie

Date

2010-09-28T11:49:33-06:00

ID

160105

Comment

Ye, the Milliman report is a public document . You may request a copy by emailing [email protected]

Author

Francis Rullan

Date

2010-09-28T12:00:52-06:00

ID

160106

Comment

richie makes a good point. Can you post a link to the Milliman report, Mr. Rullan? Thanks for providing your salary and for the kind words about the paper. My favorite JFP fans are the ones who don't agree with everything we write, but appreciate that we don't pull punches. As for your Medicaid numbers you just provided, I need to do homework before responding in any way. I try to make it a point not to pull responses out of my you-know-where, as I ask others to do. Your statement about the European model is quite a bit softer than your earlier statement which, quite frankly, alarmed me.

Author

DonnaLadd

Date

2010-09-28T12:01:43-06:00

ID

160107

Comment

We cross-posted, Mr. R. Why don't you or your cohort in Medicaid communications throw it up on the website and post a link to it so anyone interested could see it? That should take less time than dealing with a bunch of different e-mails.

Author

DonnaLadd

Date

2010-09-28T12:10:20-06:00

ID

160115

Comment

All, Mr. Rullan called and said they are PDFing the Milliman report and posting. Cheers to them for doing that.

Author

DonnaLadd

Date

2010-09-28T13:40:43-06:00

ID

160118

Comment

(I'm about to go off here a little. Forgive me and just let me get it out. I've been needing to do it for a while) :) Nothing really specifically to say regarding the state's inflation of health care costs...but more a general statement that all of sudden Republicans blame "Obamacare" for inflated Medicaid costs when costs of Medicaid have been rising pretty steadily (with no LARGE jumps) since 2005. The largest jump in Medicaid costs actually occurred between 2004-2005 (This is ALL coming from MS Medicaid's website btw). The Republicans refuse to see that projected healthcare costs are not "HUGE" compared to what they've been in the past five years (roughly $50 million either way for the past three years with a THREE HUNDRED MILLION dollar jump between 2004 to 2005. Coincidentally-there were a 100,000 more Medicaid beneficiaries that year than this)and that maybe the ECONOMY created by the Bush Administration had something to do with increasing costs due to increased eligibility? Because most of the studies say the increase in costs between 2004 and 2005 was due to big pharma increasing costs of drugs, actual costs of health care increasing, and the bad economy increasing unemployment and, as such, increasing Medicaid eligbility. This was all Bush. It has nothing to do with Obama. Mississippi pays on average about $500.00 more this year per beneficiary than they did in 2005. This isn't EXPLODING costs. And, if they want to jump on someone's...er, BOOTY about it...they need to stop stroking the crotch of the healthcare/pharmaceutical companies and tell them to sit the eff down and ain't NO TYLENOL worth TWENTY DOLLARS. All of these factors were, in essence, a "perfect storm" that was created by the very people who are now bemoaning it and blaming it on something it has NOTHING to do with. I get that they are shaking in their boots about the federal government restricting their right to deny coverage and care because that is how they have controlled costs in the past-denying procedures, restricting eligibility, etc. Without ways to control costs, they see them beginning to explode. What's interesting is that none of this has actually been "born out". Its just not showing up the way they say it will. When Medicaid eligbility is relaxed and there are more people on the rolls, the cost of spending on acute care actually decreases. Might it be that providing the people with coverage causes preventative care and less emergency room visits with people who have illnesses they've let get out of control? And since everyone knows a trip to the MEA is a hell of a lot cheaper than a trip to the emergency room, might it be a good idea to give people the ability to visit the MEA? Please check it, with 100,000 more people enrolled in Medicaid in 2005 and 2006 we were paying LESS in acute care costs than we are right now. If you look at it holistically its all robbing Peter to pay Paul. It all comes from SOMEWHERE. You cut Department of Mental Health funds in order to fund Medicaid...programs that were funded by DMH are now forced to bill more Medicaid in order to make their budgets. Its a stupid circle. Yes, we are looking at a huge Medicaid deficit. But, the truth is, we've been looking at a huge Medicaid deficit for the past five and a half years now...and I hadn't even heard of Obama then. ;-P I want people to STOP trying to make everyone AFRAID and understand that this country is changing and evoloving (as all dynamic entities do)which means its needs are changing and evolving and providing healthcare for its citizens is not something to be "EARNED" but something that is deserved by every human being. AAAAGGGGHHHH! I swear, I'm moving to the side of a mountain and raising chickens to sell their eggs! With my luck, I'd have chickens that needed healthcare coverage and couldn't get it because their "previous eggness is a pre-existing condition"

Author

Lori G

Date

2010-09-28T16:23:16-06:00

ID

160119

Comment

Damn, that's only about a thousand words shy of a column...Sorry. :P

Author

Lori G

Date

2010-09-28T16:24:06-06:00

ID

160120

Comment

OK, I'm impressed, Lori. Go ahead and turn it into a column. ;-)

Author

DonnaLadd

Date

2010-09-28T17:35:18-06:00