The True Meaning of Five Little Words - A Catastrophic Reality

When House Speaker Nancy Pelosi declared, “But we have to pass the bill so that you can find out what is in it. . . “ she was admitting she didn’t want anyone to know what was actually in the bill until it was too late to do anything about it. And there was good reason for the Democrats to keep everyone in the dark. As more and more details are brought to light in the 2,704 pages, the magnitude of how far-reaching and damaging this bill actually is, is numbing.

One of the newest revelations that has been discovered is on page 466 where a provision that changes the definition of “medical assistance” is found and has the potential to destroy state budgets in yet another way as if they needed any help.

States have been required to provide payment for services by physicians to Medicaid recipients. However, recipients have found it more and more difficult to find doctors who will see them because states, whose economies are in the tank, have cut payment rates to doctors who can’t absorb the cuts and stay in business.

Not to worry. The new law will solve that problem. From now on states will be on the hook not only to pay for services of Medicaid patients, but will required to make certain they’re seen by a doctor. In other words, states will be liable for ensuring provision of “the care and services themselves.”

By changing the definition of Medical Assistance, Section 2304 potentially throws out years of court precedent that has protected state from losing expensive lawsuits. Henry Waxman (D-CA), Chairman of the House Energy and Commerce Committee, hasn’t responded to requests for comment on this new provision.

Why? Victor Schwartz, a tort law expert, explained that Waxman is of the opinion that trial lawyers are positive agents of change and sees tort law as a regulatory engine that is needed in addition to legislation. Waxman holds the view that trial lawyers are heroic and there to help the little guy.

That may have been how it was when Waxman was practicing law 30 years ago, but things have changed radically. Now heroics don’t play a part in lawsuits anymore; it’s big business on the same scale as Exxon.

And that’s where the expanded definition puts states, and consequently, the taxpayer, in the crosshairs. It leaves every state vulnerable to a lawsuit any time someone cannot find access to service.

But, of course, not all state Medicaid directors are concerned about the change to the law. There are some who feel the new wording will make little difference and others who aren’t even aware of the “change,” (that should be comforting to taxpayers in those states).

Doug Porter, an assistant secretary of social and health services in Washington state seems to be apathetic and justifies his attitude with the flippant comment, “I’m in the ‘makes little difference’ camp. We here in the 9th Circuit are used to getting sued.”

Washington state isn’t unique. Yet, what’s taking place there would be comical if it weren’t so serious. While the state’s Attorney General is joining other states in pursuing a lawsuit questioning the constitutionality of the Healthcare Reform Bill, Governor Gregiore is moving ahead at top speed to implement it even while the state is facing a $2.8 billion deficit. Of course, the fact she’s gunning for a federal appointment doesn’t have anything to do with her determination to burden the state’s taxpayers with the cost of healthcare reform.

Responsible states are trying to determine the impact of the change. The House Report on the legislative language describes the change as merely clarifying the long-held understanding of state requirements.

That’s not the opinion of many state officials who feel the language wipes out years of litigation precedent that protected states from Federal encroachment by federal judges. In just about all the cases where federal judges have imposed their discretion, it has cost states hundreds of billions of dollars. That pretty well wipes out Waxman’s perception of trial lawyers wearing capes and fighting for truth, justice, and the American way.

Louisiana is an example of what could happen. If a Medicaid recipient sues because he is unable to find a physician to see him or her and wins, that will force the state to increase payment rates to doctors. Louisiana has spent $300 million just over the last three years to increase its payment rates for 30,000 elderly and disabled Medicaid recipients.

More than a quarter of its 4.5 million citizens are already on Medicaid and around 400,000 more are expected to join the program due to expanded eligibility standards that are in Obamacare. You do the math. The cost to the state and, ultimately, to the taxpayer will be devastating.
Posted by LG 04/05/2010