Anything.
Simply did not interfere with availablity of the services that should be available under medicaid. Many states simply play a run-around game with letting those who are eligiblefor services, to know that they are, and where they can get the services.
In many cases. like Deans Vermont, the state had a very low number of people who lacked insurance to begin with, and so the illusion that a great deal of services are available, when the statistical data states otherwise.
Like this article:
State's safety net for kids chided
Children First gives Oregon a C grade overall.
PETER WONG
Statesman Journal
September 16, 2003
A sagging economy and a tattered social safety net have caused a children’s advocacy group to downgrade Oregon dramatically, including an F for family financial stability.
The fourth annual report card, which Children First for Oregon released today, gave the state an overall grade of C-, a whole grade down from the B- it gave last year and in 2001.
Even more dramatic were the downgrades in family financial stability, which dropped from D to F, and health from B+ to D.
“A financially stable household is a foundation for a safe, secure childhood,” executive director Marie Hoeven said.
In addition to Oregon’s high unemployment rate — which is 2 percentage points greater than the national average — more then 140,000 children live in poverty and find it hard to get food, housing and medical care. That’s about one in six children, Oregon’s highest rate since 1994.
“The economic downturn has highlighted the fact that a lot of families always were on the borderline,” said Tina Kotek, policy director for the group based in Portland.
“It also exposed the lack of a social safety net that would have kept those families somewhat stable, instead of falling through the cracks.”
http://news.statesmanjournal.com/article.cfm?i=67805PORTLAND -- In the mid-1990s, Dr. John Kitzhaber, an ex-emergency room doctor turned politician, engineered a systematic approach toward the state's uninsured problem. Known as the Oregon Health Plan, the program expanded the number of people eligible for state-sponsored health insurance. Oregon's traditional Medicaid program covered about 300,000 people. From 1994 through 2002, an additional 91,000 to 121,000 people gained insurance through the plan. This year, the number went down to 62,000 when a tight state budget forced cuts in benefits and the addition of co-payments and premiums.
The Oregon Health Plan stretches the state's dollars by adopting a rationing approach to health care. Instead of paying for all medical procedures, the plan covers a select number of benefits so that it can insure more people. An appointed committee draws up a list of benefits and ranks them by medical priority. The legislature decides how much money it has and where to draw the line on the priority list. The program only pays for benefits falling above the line.
Kitzhaber, who finished his second term as Oregon's governor in January, says national and state health care programs sorely lack the pragmatism of the Oregon Health Plan. The straight-talking Democrat ex-governor is on a mission to change that. Speaking around the United States and world, Kitzhaber is attempting to redirect health care policy.
He criticizes a national safety net that provides care for the uninsured through expensive emergency room care, rather than paying for more effective and cheaper preventive care. He blasts Medicare, the federal program for seniors, because it devotes public funds toward covering rich, retired Americans when so many poor people lack insurance. And he insists that rationing care is a fair way to deliver medical care to the poor.
http://www.bayarea.com/mld/cctimes/business/6769164.htmRationed care is an ultra-conservative idea about health care, in which is it is simply TOO costly to cover someone, you dont cover them, if they have a condition that is not part of the rationed service, the person just has to die, if they cannot afford it themselves.
Not a very pretty sight.
And it is similart to what Dean did. One of the Premises for CLinton care was to start shifting funds to cover children, because it is realtively cheap compared to covering adults. Children lets face it, have lower rates of chronic illnesses, and for the mst part, require simple maintenance treatment. Whis is why Kerry wrote the initial acts that allwed the states, and Vermont was one of them, to use federal medicaid waivers to cover people who were above the federal poverty levels, by using unspend federal funds that originally given to the states for non health related programs, and which Dean used to fund Dr Dynasaur:
Beware Kidcare
Sen. Tom Daschle (D-S.D.) recently announced a $3 billion to $4 billion per year proposal that would subsidize 90 percent of private health insurance premiums for families with annual incomes up to twice the federal poverty level and provide smaller subsidies for wealthier families -- those that earn up to $75,000 per year. Another proposal unveiled by Sens. Edward Kennedy (D-Mass.) and John Kerry (D-Mass.) would establish federal-state-private partnerships in which states, using federal dollars, would purchase private "child-only" coverage at an annual cost of about $9 billion. Premiums would be fully covered for families with incomes up to 185 percent of the federal poverty level and completely phased out for families above three times the poverty level -- over $45,000 for a family of four. Sen. Arlen Specter (R-Penn.) offered a similar proposal that would completely phase out the credit at 235 percent of the federal poverty level over $35,000 for a family of four -- at an annual cost of $4.8 billion.
The catalyst for KidCare is the supposed explosion in the number of children lacking health insurance and, therefore, presumably receiving inadequate care. However, in reality, the percentage of uninsured children rose less than 1 percent from 1990 to 1995, from 13.0 percent to 13.8 percent -- hardly an explosion. Of the 10 million children who lack health insurance, 3 million are eligible for, but not participating in, Medicaid, the federal-state health insurance program that covers children of families whose incomes fall below 130 percent of the poverty line. It is estimated that another 1.5 million uninsured children live in households with incomes over $40,000 per year. Moreover, most uninsured families lack insurance for only a brief period. Over half of all uninsured Americans go without insurance for less than six months. Furthermore, KidCare proponents fail to distinguish between health insurance and access to health care.
http://www.cato.org/dailys/2-11-97.htmlThis is a conservative article doing a burn on the KidCare program, but look familiar...It is very close to Vermonts's Dr Dynsaur program
as it was changed to in 1998, after the bill finally passed as the Kennedy/Hatch Act, and what the states did regarding children again, was standard medicaid.
Problems that developed was that states started cooking the books, under budgeting programs for roads, dams and other non-health related programs, and this occurred in Vermont as well. In Vermont particularly:
Governor's Bipartisan Commission
On Health Care Availability & Affordability
Final Report
I. Authority, Scope
A. On January 24, 2001, Governor Howard Dean issued an executive order establishing a Special Governor's Bipartisan Commission on Health Care Availability and Affordability...
A. Our commission is made up of people who have spent years listening to testimony and otherwise studying the problems of health care availability and affordability. We have differences, some of them passionate differences, in our political philosophies, and it should come as no surprise that we differ on some of the directions reform should take. Although we have taken a substantial amount of new testimony during the past nine months, our real task has been to try to find common recommendations, despite our philosophical differences.2
B. Based on what we have learned, we do agree on this: Health care in Vermont is near a state of crisis -- some of us would say it is already in crisis -- and all health care sectors are on edge. We also note that many of these problems are national or even global in scope and that our abilities to solve them at the state level are limited.
C. Health care costs in Vermont, now exceeding $2 billion a year, are of a sufficient magnitude, however, and are increasing at a sufficient rate to place state government itself in jeopardy, including every program for which it appropriates money. By comparison, Vermonters budgeted $1.8 billion for all state government services in FY 2001 (not including federal funds).3
We are rapidly approaching the point at which these costs will directly conflict with our ability to do such things as to maintain roads and bridges, for example, or to provide cost-effective services to our infants and children, to promote agriculture and tourism, or to provide any other services our citizens have come to expect.
http://216.239.37.100/search?q=cache:aC9QzqwOEmkJ:www.state.vt.us/health/commission/docs/report/mainreport.doc+%22Howard+Dean%22+%22Incentive+Plan+for+Medicaid%22&hl=en&ie=UTF-8Or to put it simply, in Vermont, in order to try to fund health care, particularly for children, federal funds for other projects were being raided, but the state was not increasing its budget to compliment these programs as required by Medicaid regulations. These waivers were only temporary, and cannot be extended, so they were being misused for political ends, and did not end up increasing the number of peopple with insurance coverage in the states that used the waivers, but most particularly in Vermont, where Deans agenda was primarily political, and not in the interests of the people who most needed health care. In Vermont, what occured was a health coverage shift, not health coverage expansion. No cost controls were implemented, ever, so the insurance and big health care companies called the shots, and the budget for other govenrment services were drained, but the number of adults who had coverage was not increased.
As the Bush cuts to the states kicked in Deans solution to the problem was refuse to raise taxes, and as a matter of fact, to go full steam ahead on the income tax cuts he asked for in 1998/1999, and which began in 2000. Deans solution in the end, was to cut services, and increase the out of poicket expenses for the adults who were covered by medicaid:
Governor’s Budget Cuts Medicaid Programs
Governor Howard Dean, in his eleventh and last budget address, cut several Medicaid programs including prescription drugs, dental care and vision services. Dean told lawmakers times a tough and sacrifices had to be made.
The Dean budget for FY 2003 is $891 million in state spending, one percent more than the state expects to spend this fiscal year but nearly 3% less than the budget passed last year ($916 million). Revenues this year are expected to be $50 million below budget. Dean wants to use the "Rainy Day" fund to cover some of the $50 million shortfall but does not want to tap that fund for FY 2003. Next year’s budget is based on revenue estimates of $893 million.
If passed as presented, Dean’s budget would:
Eliminate the VScript Expanded Program.
Reduce the Vermont Health Access Plan pharmacy benefit.
Increase the co-pay up to $750/year for medicines under both the VScript and VHAP pharmacy programs. (Those eligible now pay only a few dollars for each filled prescription).
Eliminate the Medicaid dentures, chiropractic and podiatry programs.
Reduce the adult dental programs (cover pain and suffering only, not preventative care).
Add a 50% co-pay to adult vision programs.
Add a $250 co-pay per admission to VHAP inpatient hospital benefit.
Reduce the hospital outpatient payment by 10%.
Establish a hospital outpatient co-pay of $25.
These cuts would save about $27 million, $11 million in state money. Few advocates for the elderly are happy with the budget and have vowed to restore the money lost to these programs. A coalition of over a dozen advocacy groups held a rally and press conference at the Capitol building to denounce the budget cuts.
http://vnavt.com/vahhavoicewinter2002.htmEssentially, all this resulted from poor planning on Deans part, and his unwillingness to change his fiscal policies as the times and situations warranted. Dean. like Bush has a one size fits all solution to government problems which, like Bush' revolves around fiscal conservatism. Reduce government spending, use surpluses to cut income taxes. This is how Dean ran Vermont as governor.
And also resulted in his need to recommend cuts to social services in 2002. He forgot the first dictum of funding government programs. Plan for the worse, hope for the best.
Which while govenror meant cutting state budgets, state funding of programs, while at the same time, refusing to raise income taxes, and in fact in Deans case, cutting them.
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