Burden of Health Care

Some of the lower income individuals would be covered by an expansion of Medicaid, the state-federal health program for the poor. In this case, adults up to 150 percent of poverty - individuals making up to $16,245 and a family of four up to $33,075 - would, in theory, be covered. This would add 15 million to Medicaid. That number is far below the number of poor and illiterate that populates our states. Further, Medicaid is a pig-in-a poke since Governors control the percent of people enrolled in Medicaid and in tight economic situations they simply cut
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Nevada Governor Jim Gibbons cut Medicaid payments during the H1N1 epidemic to hospitals by 5% across the board, and some physicians, especially pediatricians specializing in orthopedics, urology and cancer, saw their Medicaid payments reduced by 41%.

Gibbons has also proposed to eliminate Medicaid coverage for low-income pregnant mothers. The state has already reduced personal-care assistance to the elderly and disabled. He has capped dental benefits under the state's SCHIP program at $600 a year, and eliminated orthodontics and vision coverage. Further, Gibbons has capped enrollment at 25,000 for the program, which already has 23,000 enrollees and pending applications for 7,000 children.

The cuts mean $21 million less in Medicaid funding for the State's public hospital: The University Medical Center of Southern Nevada, Las Vegas,. The cuts add to the expected loss of $51 million, about 10% of the hospital's net revenue, for uncompensated care.

The Medical Center has already stopped accepting new patients at the outpatient oncology clinic, and has canceled a contract for outpatient dialysis. It also ended routine prenatal care, thus leaving 600 women to find other providers, and it discouraged women with high-risk pregnancies from using the hospital by closing a unit that was losing more than $2 million a year.

Congresswoman Dina Titus, (D. Nev.), attempted to put a positive spin on H.R. 3962 by arguing that the Act, will ban insurance industry practices of discriminating against those with preexisting conditions or withdrawing coverage for people when they get sick. In addition, the legislation will close the so-called donut hole that forces nearly 13,000 seniors in her district to pay high out-of-pocket costs for prescription drugs.
Further, the congressional version, Titus argues, eliminates co-pays for preventive services and "gender rating" by insurance companies. Gender rating is particularly onerous and has led to women paying up to 48 percent more in premium costs than men for coverage through the market place.

One particularly interesting provision of the act ends the insurance industry's exemption from anti-trust laws that has allowed them to stifle competition. Further, there is a grant program to encourage states to implement alternatives to traditional malpractice litigation. The Act also permits states to enter into agreements to allow for the sale of insurance across state lines.