The local newsblog posted two marginally related stories together in the printed version of their online material today. The first was a story out of Birmingham. The story was at its most basic level a press release and a response. The release offers information on:
research by University of Alabama at Birmingham School of Public Health economists David Becker and Michael Morrisey, who say expansion in Alabama would provide Medicaid coverage to an additional 300,000 people and generate $20 billion in economic activity. That,they say, would add $1.7 billion in tax revenue to Alabama coffers from 2014 to 2020.
Take away $770 million in estimated Alabama costs, and the net gain in tax revenue is about $930 million, Becker said.
The response is a predictable one from our Republican Governor:
Gov. Robert Bentley on Tuesday reiterated his stance against Medicaid expansion under the federal Affordable Care Act following the release of a UAB study estimating $1 billion in new tax revenue under such an expansion.
“Gov. Bentley will not expand Medicaid under its current structure,” said governor’s spokesman Jeremy King. “Our priority right now is fixing the system we have, not expanding a broken system.”
The article next to it is a report on the United Foundation’s health ranking for Alabama. The headline reads “Getting healthier (Just Barely). The statistics are fairly bleak:
- High prevalence of smoking
- High prevalence of obesity, sedentary lifestyle & diabetes
- High prevalences of low birthweight & high infant mortality rate
So, how are we healthier? Turns out we were ranked number 48th last year and are number 45th this year. Why? Our children are better off than Mississippi and other neighboring states. In part this is because two thirds of Alabama’s children, as a consequence of the economy, are eligible for the supplemental nutritional assistance program (food stamps). It is also because of Medicaid with only 15% of these children having no insurance.
Perhaps when the governor finds out that the “new” Medicaid, hugely changed by virtue of the fact that enrollment is exclusively income based, has a different structure he will relent. After all, he is a physician and in the words of one of the investigators:
“If chronic conditions are better managed; if mental health is better managed, we have people who are more productive,” Becker said. “That’s certainly good for the state.”
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December 13, 2012 at 4:09 am
Robert C. Bowman, M.D.
From the Sept NYTimes and Tavernise – “For generations of Americans, it was a given that children would live longer than their parents. But there is now mounting evidence that this enduring trend has reversed itself for the country’s least-educated whites, an increasingly troubled group whose life expectancy has fallen by four years since 1990.
“The steepest declines were for white women without a high school diploma, who lost five years of life between 1990 and 2008, said S. Jay Olshansky, a public health professor at the University of Illinois at Chicago and the lead investigator on the study, published last month in Health Affairs.”
Behind by design makes matters worse – decreases in employment, decreases in employment related insurance, increases in Medicaid costs, and fewer reaching the age for Medicare, especially if the age is increased to 67 years.
Lower and middle income males are falling off in education, higher education, and medical education access. Fewer complete education and various levels of higher education.
There are indications of failure in highest income populations (US med students – JAMA, Andriole) where males were 1.5 times more likely to fail compared to females for 1995 – 1999 US med school grads. Trajectory suggests worsening of males relative to females at all socioeconomic levels.
Across zip code, county, state, or other populations – those not highest income, most urban, children of professional, and female are falling behind by designs for child well being, health, health care, education, economics, and more.
December 13, 2012 at 2:50 pm
Robert C. Bowman, M.D.
Watching states fall behind: California
California now has the largest population of uninsured with declines in coverage and increases in population and movement to 7th worst in the US.
California Medicaid is rated last by patients and providers.
An annual update is noted http://www.chcf.org/almanac:
Nearly one in four workers in the state is uninsured.
Employees in businesses of all sizes are more likely to be uninsured in California than in the US as a whole. In businesses with fewer than ten employees, slightly more than 40% of workers are likely to have no insurance.
Nearly one-third of the uninsured in California and the nation have annual family incomes of $50,000 or more.
Fifty-four percent of California’s uninsured children are in families where the head of household worked full-time during 2011.
Nearly 60% of the uninsured population is Latino.
Those who are preserving their profits by shorting insurance are contributing to the crises in health access, more for fewer, and the need for state coverage.
Are you shifting your Christmas shopping, your choice of home delivered pizza, and your daily purchases to businesses or products associated with health care coverage for workers – or do you buy from those that leave their employees out of the picture? Do your dollars stay with local business or are they shipped out to national corporations that care only about driving local competition out of business?
And California is one of 6 states with top consumption of physicians and other health care providers per person. There is more than enough for all, but somehow few benefit.