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* “This is the thing that keeps me awake at night,” Illinois Department of Healthcare and Family Services Director Julie Hamos told Crain’s. What’s keeping her awake? The lack of doctors in the Medicaid program ahead of a big expansion…
Many physicians have historically shunned the program, in part because of its low fees. Roughly 16 percent of the state’s 47,000 doctors aren’t even signed up for Medicaid. Even among those who are, the overwhelming majority infrequently see patients, leaving the care concentrated in the hands of a few, according to a Crain’s analysis of payment records published last year. […]
While the influx of patients likely won’t be disruptive across the country, the shortage will be felt in areas with a large number of uninsured and few doctors to begin with, said Dr. Huang, director of the Center for Translational and Policy Research of Chronic Diseases at the University of Chicago.
* HFS has temporarily increased reimbursement rates, but that may not be enough…
Board-certified pediatricians, internists and family medicine practitioners are among those eligible for the higher fees, according to a March 4 notice published by the Department of Healthcare and Family Services. Physicians who aren’t certified in those specialties are also eligible if at least 60 percent of their annual billings are to Medicaid.
The temporary rate change makes Medicaid reimbursements equal to the higher fees paid by Medicare for about 180 billing codes for primary care services, such as vaccinations and check-ups, said Dr. Arvind Goyal, medical director for the HFS division of medical programs. Rates vary per service, and the increase only covers services rendered from Jan. 1 through Dec. 31, 2014, when the higher rate is set to expire.
posted by Rich Miller
Wednesday, Apr 10, 13 @ 9:18 am
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can something be done about the time it takes the State to pay doctors and hospitals? This is one of the problems medical professionals have expressed to me about providing care.
Comment by Amalia Wednesday, Apr 10, 13 @ 9:23 am
Why not offer some kind of incentive to the docs? Maybe offer some kind of assistance in paying off their student loans or something.
Comment by So. ILL Wednesday, Apr 10, 13 @ 9:24 am
Doctors need to step up and take some Medicaid patients. Ask not what your state health care system can do for you…
Comment by Dan Bureaucrat Wednesday, Apr 10, 13 @ 9:36 am
So.Ill if you are a doc who works at special clinics called FQHC or public hospitals etc. you do get your loans repaid. I agree maybe if you have a large practice of Medicaid patients this should also qualify you for loan repayment. As to paying bills on time, medical providers are getting higher payments when they are made late due to the amount of interest the state is paying. Works great for large providers who have another pool of money to tap, but small practices cannot survive.
Solutions are many: higher reimubrsement, timely reimbursement, loan repayment, simpler billing process (so less time with clerical staff on coding and re-billing).
Then for long term solution increase the number of persons who can train as doctors. This number is finite partially due to the way the loans are financed as well as medical groups. Obamacare has increased funding for training medical personnel but it will take years to see the effect of more doctors.
Comment by illinifan Wednesday, Apr 10, 13 @ 9:38 am
This is a real problem. My former doctor saw a lot of Medicaid patients, which I really respected. However, because of the low reimbursement rates, she increased the number of patients she saw each day, reducing the amount of time she could spend with each patient.
After a while, I got tired of the “super-busy doctor puts hand on door handle and asks `any questions?’” approach and chose a new doctor with a less-active social conscience but with more time to spend with her patients.
Comment by soccermom Wednesday, Apr 10, 13 @ 9:49 am
Why we don’t take medicaid in our dental office: The state pays roughly $13 for a cavity filling but I have to spend $16 - $19 in composite material. Cheaper material is available but I am not going to use it as it is cheap and won’t last, etc. I am not going to give some patients good material and others bad material just because of insurance so I am just not going to take it. Dental insurance is on the decline. It will eventually be all pay services and their will be very few policies or people that take them.
Comment by Why? Wednesday, Apr 10, 13 @ 9:49 am
“Doctors need to step up and take some Medicaid patients. Ask not what your state health care system can do for you…”
So, as a physician and medical practice owner (read “business owner”), by initial reaction to that statement is “make me.” But on second thought, someone in this state might actually take that seriously. So, my actual comment is that I will take Medicaid when I’m paid enough to make a profit at it - which I’m not. My decisions on which insurance plans to take are purely financial. Currently, Medicaid pays me less per patient than the cost of seeing those patients. And a 2 year bump in payments is not enough to make me feel differently about the situation. Make the bump permanent and I might reevaluate the business decision not to accept the Medicaid insurance plan.
One more thought. Asking doctors to see more Medicaid is the equivalent of asking them to voluntarily pay more taxes. Instead, I think the people of Illinois as a whole should be asked to pay more taxes in order to properly fund Medicaid. Maybe then there will be some political support for meaningful structural reforms like such as the Florida Medicaid Pilot Program.
Comment by Confused Wednesday, Apr 10, 13 @ 9:52 am
@ Dan,
Your statement is based in fantasy. Reimbursement rates are so low for Medicaid patients that it’s not good business to see those patients. Coupled with the fact that if you DO see a patient, you won’t get paid for 9 months…makes it a very unattractive prospect.
What would you do if your boss said that from now on, you need to do 25% of your job for free…and that you would only be paid 9 months after you did the work. Would you do it?
Comment by How Ironic Wednesday, Apr 10, 13 @ 9:52 am
i had a dentist, right out of school, who took over my previous dentist’s practice. this was ten years ago in spfld. he took medicaid patients as he was building his client base. eventually, he phased out the medicaid patients. last year he dropped those w state insurance, solely because of the slow pay, not the rates. i cant blame him.
Comment by langhorne Wednesday, Apr 10, 13 @ 9:59 am
walker tried to control medicaid cost increases by freezing reimbursement rates. an iefc study found that docs responded by changing their billing codes, to slightly higher categories, to achieve the desired revenue flow. not outright fraud–they didnt bill for services not performed. but a followup visit might become a followup visit w some sort of additional treatment.
Comment by langhorne Wednesday, Apr 10, 13 @ 10:04 am
=== - Dan Bureaucrat - Wednesday, Apr 10, 13 @ 9:36 am:
Doctors need to step up and take some Medicaid patients. Ask not what your state health care system can do for you… ===
Even if it puts them out of business? I wonder how many doctors were consulted when this FUBAR system was to be expanded, or the national program was put into place. Expecting folks to provide a service for less than they can afford to provide it is outrageous. Would we expect anyone else in another line of work to do so? Hey, I have a need to get to work so I can maintain my health insurance - but the transmission in my car is on the fritz. I demand that AAMCO fix my car for less than it costs to fix so that I can get to work. Or, better yet, I demand that taxes are raised on the rich so that AAMCO can be subsidized and my car can be fixed. Can you even see folks seeking to become physicians when they see there is no way to make a living at it?
Using guilt to get folks to change how they do business is not a logical business practice. Using market forces to do so is a proven strategy. I would point folks to Lasic surgery - in the beginning it was quite costly. However, over time, economies of scale had an effect on costs as well as the pressure of competition leading to better techniques that reduced the cost of the care. We have seen a greatly reduced cost for an elective procedure rarely covered by insurance so that many folks can afford it. We have also seen that the care is safe and the results reliable. I know folks don’t like the idea of competition in health care but I think that is shortsighted.
Comment by dupage dan Wednesday, Apr 10, 13 @ 10:08 am
It is often pointed out to me that the government is incapable of doing anything efficiently. The reluctance of physicians to embrace Medicaid is nothing new. Only our government would be so inept as to try to vastly expand the program without first making it work effectively. From some of the stories I have heard, Medicaid treatment is little better than no treatment at all anyhow.
Comment by Skirmisher Wednesday, Apr 10, 13 @ 10:08 am
This is just the start of what will happen when “ObamaCare” kicks in.The country’s health care is headed towards disaster.
I would bet that Illinois does not set up their own insurance exchange. It is to costly and the Feds will not guarantee payments for all the additional Medicaid enrollments that will follow.
Comment by MOON Wednesday, Apr 10, 13 @ 10:11 am
what are the problems that cause the slow rate of pay? spend some time at night worrying about that, Ms. Hamos, because if you fix that you might find doctors more willing to participate and folks like soccermom more happy with doctors who do have a social conscience.
Comment by Amalia Wednesday, Apr 10, 13 @ 10:17 am
Somebody’s cashing those billions in Medicaid checks.
Is it the highest level of care? I doubt it. But you get a lot more health care with Blue Cross PPO then you do with Humana HMO, too.
Comment by Wordslinger Wednesday, Apr 10, 13 @ 10:18 am
There is a problem that the reimbursements are too low. That has been established.
So what do doctors need to do to step up and take some Medicaid patients? How do doctors help us get where we need to go? Or should doctors just stay out of it?
No need to ask me how much free unpaid work I do for my state, or give me examples of other people not wanting to do it.
Comment by Dan Bureaucrat Wednesday, Apr 10, 13 @ 10:19 am
Anybody who thinks that a massive expansion of healthcare will be implemented without problems is fooling themselves. However, you dont allow a fiscally unsustainable system that leaves millions uncovered to continue because of the potential pitfalls of taking action. This wont be easy, but its the law, and everybody needs to figure out how to implement it. If everybody would put forth the same effort to make it work as they have to try killing it, we may not be facing some of these problems right now. People need health care. Figure it out and deal with it.
Comment by anon Wednesday, Apr 10, 13 @ 10:22 am
Moon…doing nothing on health care will also head us to disaster. At least Obamacare is a step towards changing the system. It is not perfect but that is the purpose of laws to help change what does not work. That is much better that yelling lets keep the status quo. Instead of of trying to undo the bill, it would be better to fix what does not work.
Comment by illinifan Wednesday, Apr 10, 13 @ 10:22 am
How about shifting some tasks currently performed by doctors to nurse practitioners. I think there are some pilot projects out there in some parts of the country, might require changes in state laws, not well-received by the doctor associations I suppose. But given the dearth of physicians in rural areas, seems like some adaptations would be needed.
Also, more use of technology. I read recently of a rural emergency room which was partially staffed remotely. Interesting.
Comment by cassandra Wednesday, Apr 10, 13 @ 10:24 am
Well Dan to be blunt, a big part of the answer is to take doctors out of it.
You would have more care done by folks a bit further down the pay/education food chain. That is NPs and PAs and even non masters prepared nurses and you would have ‘faster’ care, that is care more like what you get at a minute clinic.
Cassandra as to your point with the AMA here and the Illinois Medical Society, Illinois has one of the most restrictive policies when it comes to scope of practice for NPs and PAs (it was quite the fight to let an NP sign a school physical if I recall).
Comment by OneMan Wednesday, Apr 10, 13 @ 10:37 am
Also full disclosure OneWife is an NP as sees folks with bridge insurance for a different government program at their homes as part of a preventative program.
Comment by OneMan Wednesday, Apr 10, 13 @ 10:38 am
No Sympathy for the Doctors
AMA is Strongest Union in the Country - They Restrict Membership by Limiting Domestic Medical School Admittance - Then holler shortage - pay us more
Drs. Price Fix, Live High on the Hog , Think they are the “Provider” not just the provider, want to dodge liability for their malpractice , and whine about most everything.
Make accepting Medicaid Patients a Condition of being granted a License to Practice Medicine in Illinois - Legal ? Don’t know ?
But think of all the jobs the litigation would create and the Drs.’ Jaguars in the Courthouse parking lots would make great TV footage.
( Hope Dr. Knife don’t see this or color me gone)
Comment by x ace Wednesday, Apr 10, 13 @ 10:42 am
A change to the scope of practice laws needs to be made to allow nurse practitioners to provide care up to the level of their training. The status quo protects physicians in a way that will lead to a severe shortage in providers. NPs and PAs i new models of care can meet this need especially for primary care. The entire country needs to get on board with the but the medical schools and their lobbyists are activated to block any changes to scope of practice laws. It is harmful to patients who will face long lines and fatigued physicians. Add to the shortage the aging and retirement plans of doctors and watch the crisis grow.
Comment by HC Wonk Wednesday, Apr 10, 13 @ 10:44 am
I would assume that nurse-practitioners would charge less. I would then assume that Medicaid and state insurance plans would authorize even lower payment rates…. which would leave us right back in the same place.
Only two things will solve this:
1. Raise the reimbusement rate and shorten the payment delay time. OR
2. Create clinics staffed by government employee physicians and paid for out of the general renevue fund to see Medicaid patients. shffespecial
Comment by mythoughtis Wednesday, Apr 10, 13 @ 10:59 am
Raise the annual state licensing fee of doctors who don’t see Medicaid patients and eliminate the annual state licensing fee for doctors who end up seeing more than 1,000 Medicaid patients in a year?
Comment by Robert the Bruce Wednesday, Apr 10, 13 @ 11:04 am
=== Make accepting Medicaid Patients a Condition of being granted a License to Practice Medicine in Illinois - Legal ? Don’t know ? ===
Great way to insure that a person decides to go into another profession.
Comment by dupage dan Wednesday, Apr 10, 13 @ 11:04 am
The cost of health care in the United States is about 18% of GNP. Most first world countries run between 9% and 12%. They also have longer life expectancies then the United States. We need to reform the way health care is delivered rather than worrying about how to pay more to health care providers. Increasing the responsibilities of nurse practitioners would sounds like a reasonable step.
Comment by Bigtwich Wednesday, Apr 10, 13 @ 11:05 am
=== Somebody’s cashing those billions in Medicaid checks ===
So, I guess all’s good, huh? I wouldn’t use that as a yardstick to measure the health of the system. Seems there are other variables that you left out of the equation.
Comment by dupage dan Wednesday, Apr 10, 13 @ 11:07 am
would sounds?
I must have been thinking of Norwegian Wood.
Norway, 9.5% of GNP.
Comment by Bigtwich Wednesday, Apr 10, 13 @ 11:11 am
Wow, where to start on this…
Drs.Price Fix: Ummm, no. Reimbursement rates are set by insurance companies, not doctors. Even if you charge more than ’standard and customary’, that is what the insurance company pays so even if you charge over that, that is what your most reliable payer pays.
Live High on the Hog: Umm, considering the amount of education an training a doctor has to undergo not sure if 200K average salary is living High On The Hog http://www1.salary.com/Physician-Family-Practice-Salary.html
Think they are the “Provider” not just the provider… Not sure what the heck that is, so skipping this one.
The liability thing: Well considering how much the insurance has gone up and how much more expensive it is here vs Wisconsin for example I can see my docs complain. Hell imagine if your homeowners was several times more expensive than it was if you lived in Wisconsin.
The Malpractice thing.. There is a grain of truth here, however most doctors understand if they legitimately screw up there should be liability. But not every negative outcome in medicine is the result of malpractice, but if you watch the attorney TV ads you would never figure that out.
Comment by OneMan Wednesday, Apr 10, 13 @ 11:18 am
Walgreens will begin seeing customers needing minor medical attention. If we continue believing governments can handle health care, expect Walmart to become our next hospitals.
Comment by VanillaMan Wednesday, Apr 10, 13 @ 11:25 am
x ace - I bet you think BIG PHARMA is on the take, too? They’re all in it for the money and they are all in a conspiracy to defraud us all. You should probably start taking that herbal anti-psychotic remedy again. Your delusions are showing.
Comment by dupage dan Wednesday, Apr 10, 13 @ 11:25 am
==Great way to insure that a person decides to go into another profession.==
Or another state. Many of our medical students are already fleeing the state due to med mal. Do we really need to encourage the rest of them to pack their bags and head for the hills, too?
Comment by Dr. No Wednesday, Apr 10, 13 @ 11:28 am
The medical group that I frequent is expanding to include emergent care centers. these places fill the need for “emergency” care that really does not require an emergency room and surgeons. things like a sprained ankle, sudden fever, etc. they use a combination of nurse practitioners and docs. The hope is to get people in on an emergency to be sure to connect to a primary care physician, which would help tremendously with health care.
personal responsibility on the part of patients to seek annual exams is a key of health care organization also.
Comment by Amalia Wednesday, Apr 10, 13 @ 11:30 am
VM for what it is worth, some chronic stuff can be managed by an NP or PA fairly well. That is what my wife did for 10 years as part of a specialty practice.
Comment by OneMan Wednesday, Apr 10, 13 @ 11:33 am
WOW at some of the comments.
Perhaps those demanding more from doctors missed an interesting CNN piece 2 days ago titled “Doctors Driven to Bankruptcy”.
“Oncologist Dr. Dennis Morgan had a profitable solo practice in Enfield, Conn., for years. Revenues began to fall, he said, when reimbursements for treatment and drugs to oncologists started shrinking.”
Further down: “Primary care doctors face similar challenges. Langley recounts one client, a solo practitioner in an underserved area of Broward County, Fla., whose patients were mostly on Medicare or lacked insurance.
As the economy worsened in the wake of the recession, fewer patients could afford to come in. Cash payments and reimbursements dropped. To come up with money to keep the practice going, she took a second job at a hospital. Still, her debt ballooned.”
Many more such examples.
Comment by Formerly Known As... Wednesday, Apr 10, 13 @ 11:41 am
Looks like the “shortage” will be the best path to removing the stranglehold doctors have on health care
About 20 years too late
Comment by CircularFiringSquad Wednesday, Apr 10, 13 @ 11:43 am
With the recession, budgets got tighter for many in the middle and working class. That means less money to pay the doctor, and less money for the doctor.
Combine that with lower reimbursement rates and you have less breathing room for the doctors to take Medicare and Medicaid patients.
Add in some proposed Social Security cuts and lower COLA adjustments alongside an aging population and it is easy to see how events are heading in a terrible direction.
By the way, if you live in a rural area, you may well be driving an extra hour for service shortly as doctors are forced to consolidate, retire or simply cannot make ends meet any longer.
Not good.
Comment by Formerly Known As... Wednesday, Apr 10, 13 @ 11:45 am
Is it so terrible to ask the medical profession to do a little pro bono work? Obviously can’t base an entire practice on Medicare patients, but a small percentage wouldn’t put them out of business.
Comment by SAP Wednesday, Apr 10, 13 @ 11:47 am
DD, I don’t think it’s all good, I think it’s a mess.The U.S. pays far more for healthcare for less coverage than any advanced nation and the docs, insurance companies and pharma are a big part of the problem.
Pharma is paying off generic drug makers to extend their patents to keep brand name prices. It’s good for them but lousy for consumers.
The Walgreen clinics are a great deal. Why pay a doctor to poke his head in a room when you can get the same level of care more cheaply and conveniently? And, if you like, you can get a flu shot at Walmart. What’s wrong with that?
Comment by Wordslinger Wednesday, Apr 10, 13 @ 11:51 am
I’m not saying they can’t.
We live in a world were everyone customizes everything in their lives. So it is frankly laughable that we tried to implement a one size fits all health care system in the 21st Century.
Folks will be paying for an obsolete bankrupted health care system while at the same time, buying free market health care solutions for their own personal needs.
Americans will handle this similarly as they handle education. Craptastic public system, premium private system. Walmart and Walgreens will be a better place to get medical attention than at the medical clinics teetering on bankruptcy, overwhelmed by patients and staffed with well meaning amateurs.
But, the craptastic system will be “free” and accessible, so problems solved, right?
Comment by VanillaMan Wednesday, Apr 10, 13 @ 11:57 am
I think the Walgreens idea is very good. So is the Walmart program. These businesses see a need and a demand and they respond to it. This is the way medical care can be expanded - thru the competitive process. Those companies that can see this opportunity and also pressure their competitors to ante up is the way to go - not trying to guilt trip doctors into accepting lower payouts. The effec, at least initially, can be the same. Doctors in this Walgreens proposal may not be paid as much but are involved in an enterprise with opportunities rather than a gov’t program where they wait for months to get paid.
Comment by dupage dan Wednesday, Apr 10, 13 @ 12:04 pm
Listening to my (foreign / European trained) primary care doctor’s opinion about the coming ObamaCare rules and restrictions, I can understand his desire to retire shortly. When I add in the opinion of a doctor friend who is in the Canadian health care system, I get a second perspective on the American health care system model.
The take-away I have is the ACA, when fully implemented, is probably the absolutely worst combination of public / private care anyone could come up. I’m not a fan of it, but it is becoming increasingly clear to me a single payer government system like Great Britain or Canada is a better alternative than the ACA. And if we allowed a 100% independent private practice system, paid for by those who could afford it or the insurance for it, alongside a government single payer plan, we might end up with the best of both worlds.
But this current mess clearly isn’t going to save any money; the only way money gets saved is by providing less health care, period. The ACA was just a compromise to keep the medial profession and private health insurance companies happy.
Comment by RNUG Wednesday, Apr 10, 13 @ 12:08 pm
VMan, I have no idea what you’re talking about. Who are these “amateurs” you speak of providing Medicaid health services?
And Walgreens accepts Medicaid and Medicare for their services.
Comment by Wordslinger Wednesday, Apr 10, 13 @ 12:17 pm
I say we lower the rates further, and make it retroactive so we don’t have to pay doctors the agreed-upon rates for work already done. Everyone seems to think this is a good idea for state employees and retirees, so why not for doctors, too?
Comment by Anon. Wednesday, Apr 10, 13 @ 12:35 pm
Yeah, VM have to agree with Word on part of this
What is up with the well meaning “amateur” comment?
Comment by OneMan Wednesday, Apr 10, 13 @ 12:37 pm
What’s also keeping Ms. Stamos up at night is the estimated 10,000 Americans turning 65 every single day. She knows that most of them are financially ill-prepared for retirement. And she knows most of them will probably look to Medicaid to supplement their Medicare.
When you, your spouse or one of your children contract a serious medical condition, you will want the best doctor you can find and you will pay anything. Gladly. When you encounter one of these fine physicians, you may come to appreciate that their abilities are the result of long years of schooling and grueling years of medical practice aggravating often daily with life and death issues.
Quality healthcare is not a right or a commodity that can be priced arbitrarily by government. It is the result of an individual dedicating a lifetime to healing.
However and in what amounts government decides to compensate healthcare professionals for those with little money, let’s keep in mind that most are highly intelligent, dedicated professionals who could probably find something else to do for a living.
Comment by Cook County Commoner Wednesday, Apr 10, 13 @ 12:50 pm
CCC, public funding accounts for more than half of healthcare spending. In any business where one customer accounts for half of revenue, they have a lot of stroke — or should.
Comment by Wordslinger Wednesday, Apr 10, 13 @ 1:02 pm
RNUG…agree with you that single payer is most likely the answer. I have a relative who is a nurse in Sweden and we have discussed how their system works. Insurance still thrives for those who can afford it and it provides extra coverage (such as a private room at hospital) that is not avaialble through the public system.
As to a doctor’s perspective on the matter, I don’t place much stock in it since they are only as informed as they want to be and the practice they have. I have family who are doctors and they are split as to whether ACA is bad or good (one is a specialist so ACA bad, the other works in a public hospital and would actually prefer single payer and get the insurance companies out of health care).
I believe the Time article about health care costs was very revealing as to who really controls the system and unfortunately ACA reforms appeased who controls the process. The money makers are the prescription drug providers, medical tech, hospitals, insurance companies. The Time article actually shows the doctors are not the big money makers as many believe they are and they are not the powers who control the process. I know some who post here won’t believe it, but it is a great article and informs another perspective.
Comment by illinifan Wednesday, Apr 10, 13 @ 1:09 pm
Until people accept that PPACA does nothing to improve actual patient medical care– did nothing to increase the amount of providers– and merely plays around with insurance statistics to impress those who don’t know better– we will continue to have this sad conversation. It did not have to be this way. The well meaning people who continue to defend ACA in its present form despite its now obvious flaws and its clearly apparent implementation failures– the people who still talk as if it can be somehow miraculously be fixed– are hurting way more than helping the poor and medically underserved.
Comment by Responsa Wednesday, Apr 10, 13 @ 1:37 pm
We will likely need to go to a two tier system - like Britain.
A bare bones (poor) public system, and an optional private system for those who want and can afford it.
Comment by titan Wednesday, Apr 10, 13 @ 1:56 pm
Responsa, first tell me what the “apparent” implementation failures are since it has not yet been implemented.
Health care reform hits on the fringes of patient care and there are currently in place a number of experimental models that are driving down the cost of care. I will not say it does enough on this issue. That said it also tackles some of the cost of insurance in that it also requires insurance companies to use at least 80-85% of premiums collected on actual patient care instead of what was previously happening where some plans only use 65% of the premiums collected for care. ACA is indeed a big package that addresses many issues. In some spots it may fail, in others there are successes (witnessed by refunds some people received this year from insurance companies since they collected more than they were supposed to in premiums).
Comment by illinifan Wednesday, Apr 10, 13 @ 2:38 pm
Doctors & dentists get screwed, while HFS pays transportation companies millions of dollars in scams…the same with child care providers, paying for a whole day if they watch the kid a certain number of half days! Doc’s, employees, retirees, vendors….who’s next??? Why, you are…if the GA can figure out a way.
Comment by Steamer Wednesday, Apr 10, 13 @ 3:59 pm
illinifan–go google what Joe Klein, Sen. Jay Rockefeller, Mark Zandi and Marilyn Tavenner all said this past week about ACA. They are and were strong supporters of health care reform. I should think their honest and public alarm sounding over the many unkept promises, unintended consequences and implementation disasters of Obamacare so far would have given you something to think about.
Comment by Responsa Wednesday, Apr 10, 13 @ 4:08 pm
DD (and Word, who is aware of this) — under law, the pharma companies are in it for the money. (to say that fancy, they have a fiduciary duty to their shareholders.) Nothing intrinsically wrong with that, at least not if you believe in capitalism.
Comment by soccermom Wednesday, Apr 10, 13 @ 6:22 pm
wait until immigration reform. Medicaid will increase beyond anyone’s expectations and will dominate the State budget.
Julie ain’t seen nothing yet.
Comment by park Wednesday, Apr 10, 13 @ 8:33 pm