Tag Archives: Medicaid expansion

Why health care is consolidating and what it means for injured workers in Nebraska.

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Nebraska State Senator Adam Morfeld spearheaded the expansion of Medicaid in 2018. The Ricketts administration has yet to implement the expansion approved by voters

Health care is consolidating; hospitals are merging with other hospitals and hospitals are acquiring formerly independent medical practices. This consolidation is driven by the implementation of the Affordable Care Act. (ACA)

Health care consolidation is likely a net negative for injured workers in Nebraska. Injured workers ultimately bear the costs of increased medical costs under the ACA, while not enjoying the benefit of the Medicaid expansion under the ACA,

Why is health care consolidating?

The simple answer is that the Affordable Care Act (Obamacare) was a driving factor behind health care consolidation because its designers assumed health care consolidation would lead to lower costs. As Joe Paduda at Managed Care Matters points out, the overwhelming weight of the data about health care cost and consolidation has shown the opposite.

Consolidated health care systems function as monopolies in the communities they serve. In theory monopolies are supposed to be illegal. But as commentators like Matt Stoller have observed, judges and regulators have effectively gutted anti-trust law in the last 40 years with more or less bi-partisan consensus. Stoller also believes consolidation leads to more corporate crime, which in the world of workers’ compensation would mean fraudlent billing practices.

In my mind, the ACA’s creation of health care monopolies wouldn’t have been feasible if anti-trust law had not been defanged. Opponents of the ACA would have had grounds to challenge the ACA on anti-trust grounds as well as the other legal arguments they used to limit the effectiveness of the ACA.

What does health care consolidation mean for workers’ compensation?

Consolidated hospitals have the power to push up medical costs in workers’ compensation. Paduda points out this is particularly true in states, like Nebraska, that haven’t expanded Medicaid. Workers’ compensation is viewed as a cash cow for hospitals, particularly rural hospitals, that are hurting for revenue

For workers, I believe if workers’ compensation insurers have to spend more money on medical care, they are going to look to cut costs on the indemnity or disability side of workers’ compensation. In short, more money for hospitals and less money for injured workers. This may lead to more pressure to reduce workers’ compensation benefits in an economic downturn.

As I mentioned earlier, the consolidation of health care is partially the result of the Affordable Care Act. The ACA has had some positive effects on injured workers. A study of the ACA showed the shifting of injuries from health insurance to workers compensation.

Expanded health insurance, particularly if not tied to an employer, also allows injured workers to treat for work injuries that have been denied by workers’ compensation insurers.

Expanded health insurance also means that more workers’ will have relationships with primary care doctors and more control over their own medical care in a work injury. But in communities with limited health care choice, injured workers may be pushed towards employer-friendly occupational medicine doctors employed by that particular health care system. The right to chose a doctor becomes moot when there isn’t an effective choice of doctors.

The offices of Rehm, Bennett & Moore, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

This entry was posted in Nebraska, Workers' Compensation and tagged , , .

Not Expanding Medicaid: Deadly Consequences

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Today’s post comes from guest author Charlie Domer from The Domer Law Firm in Milwaukee.

As previously discussed in my blog post from last year, Nebraska’s Gov. Heineman has refused to expand Medicaid under the Affordable Care Act. Although the Legislature attempted in 2013 and 2014 to expand Medicaid, it has not passed with a filibuster-proof majority.

Whether it is for politics or short-sightedness, Heineman misses the positive impact an expansion of Medicaid would mean to all of Nebraska, including its working families. The benefits of expanding Medicaid to Nebraska’s workers are outlined here.

As I wrote almost a year ago, and as Mr. Domer’s blog post below suggests, the governor’s response in this 2013 Omaha World-Herald article of essentially “eat an apple a day” and go ask your church for some help just doesn’t cut it anymore. I don’t know of too many churches handing out health coverage for an emergency appendectomy or for melanoma screenings. The coverage gap of when a person isn’t eligible for subsidies but would have been eligible for expanded Medicaid looms large for many families and workers: many of them will go without health insurance altogether.

Because there are definitely Nebraskans who are “too poor for Obamacare and … too rich for Medicaid,”even though they’re working, they can look forward to potential “dire health consequences,” as Mr. Domer writes, without insurance. I hope the 2015 Nebraska legislative session will be the year for more working Nebraskans to improve their health through the Unicameral passing expanded Medicaid coverage.

Please take a moment to ready this story out of Pennsylvania: Study: Many Will Die if Medicaid is Not Expanded.   As part of the Affordable Care Act (“Obamacare”), an expansion of Medicaid was intended.  Medicaid essentially is the joint federal-state program to provide health insurance to low income individuals and families.   The federal government strongly encouraged this expansion by the states, by offering to pay for that expansion for many years.   Unfortunately, the US Supreme Court–in upholding the constitutionality of the bulk of Obamacare–did strike down this Medicaid expansion.  The Supreme Court decision left it up to the state’s themselves to decide whether to expand Medicaid for their residents or not.

In many Republican-led states, the decision was made to not expand Medicaid.  As seen in this article, Pennsylvania was a state that declined to expand.  Wisconsin, with Republican Governor Scott Walker, also decided not to provide this expanded Medicaid coverage to the the state’s low income individiduals.  (Check out the story here and here.) 

Now comes news that failure to expand Medicaid may actually result in increased deaths among the affected population.  The failure to have this expanded coverage, according to the study examining Pennsylvanis, will result in thousands of deaths due to individuals foregoing necessary medication, medical treatment, and preventative screening. Additionally, the expansion failure will result in “catastrophic medical expenses and tens of thousands of cases of untreated depression, diabetes and missed screening tests.”   This is a truly scary scenario–and an avoidable one.

In Wisconsin, Gov. Walker is suggesting that these individuals can now obtain health insurance throught the federal-run exchanges.  The real issue is whether these low-income individuals can truly afford the premiums and whether they actually qualify for the federal subsidies.  These lower-income individuals were the one supposed to be covered by Medicaid expansion–not by the exchanges.    Based on the Pennsylvania study, if these individuals are ineligible for Medicaid and cannot secure health insurance elsewhere, dire health consequences (or even death) loom as possibilities.

The offices of Rehm, Bennett & Moore, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

This entry was posted in Medicaid, Obamacare, Scott Walker and tagged , , .