Rhode Island’s Medicaid Reforms Bank on Speculation and Shift Costs


As a state under annual threat of budget deficits that also has the country’s highest Medicaid cost per enrollee, Rhode Island can’t afford not to think about reforming the public health care program.

In the waning days of the presidency of George W. Bush and the governorship of Republican Donald Carcieri, the state experimented with a nation-leading“global waiver” to lower costs in exchange for flexibility.

Even though the experiment was largely successful, intervening governors and the federal Affordable Care Act (ACA; ObamaCare) appear to have blocked parts of the reform and let others peter out.

Now, progressive Democrat Governor Gina Raimondo has convened a Working Group to Reinvent Medicaid, with a collection of reforms of her own, designed to save or raise $91.1 million in state money next year–a little less than 10 percent of the state’s total Medicaid spending.

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  • ShannonEntropy

    Medical cost shifting has been a huge problem in this country for decades, and all the participants — governments included — are constantly trying to game the system

    TIME magazine devoted almost an entire issue to the subject


    [[ the many graphs, photos etc not in this version — sorry.
    You can buy the entire article here tho =►

    http://time.com/198/bitter-pill-why-medical-bills-are-killing-us/ ]]

    Don’t expect anyone in the medical management occupations to lose any sleep over any of this. As I like to point out, the three highest-paid employees on any University’s staff are 1.) The men’s basketball coach 2.) the football coach & 3.) the president of the hospital system

    At my old stomping grounds — Brown University — the CEO of their Lifespan hospital system is paid *five times* what Univ Prez Christina Paxson makes

  • Warringtion Faust

    I know a financial analyst/adviser who specializes in hospitals. She tells me that they have absolutely no idea of costs, nor any interest in prioritizing them. Left to the government this will eventuality lead to triage. We already see that in Britain where certain procedures are unavailable past a certain age, theory being the money is wasted because you won’t last very long.

    I recall going in for an uninsured test. Absolutely no one, the doctor, the staff, not even the woman operating the machine had any idea what it cost. They all appeared shocked at the question. I was told that they wouldn’t know until the bill came out. 20 minutes in a $23,000 machine, $1400.00. What does a 20 minute ride in a $23,000 taxi cost? A little over a year ago I took a friend to the emergency room. She was there 5 hours, during which she did little but submit to tests; $5,200.00. I took her because her situation did not seem severe and she feared that it would not be covered by insurance. She was afraid of being responsible for the $1,000 minimum ambulance ride. I do wonder.

    Shifting costs is simply a panacea to avoid cost containment.

    • ShannonEntropy

      20 minutes in a $23,000 machine, $1400.00. What does a 20 minute ride in a $23,000 taxi cost?

      If you had read that TIME article I cited, you would understand why your CT scan cost $1,400

      It is because you had to pay the entire cost yourself. So YOU have to subsidize the illegal aliens who get their
      scans for free; and the pts on Medicare which only which pays $100 for a scan; or Medicaid which pays fifty bucks

      If taxis worked like this, a ten mile ride to the airport would cost the ca$h customer a grand

      On a personal note … in March I needed an appendectomy. I was within the confines of Miriam Hospital for 26 hours. My hospital bill — *not* including the ER or any doctors’ fees — was $21,300

      But I am on Medicare + BCBSRI C&D … so how much did those guys pay Miriam Hospital, the ER & all the wonderful docs ??

      Certainly nowhere even near the amount billed. But then again … who cares ?? — I only had to pay a couple-hunnerd buck deductible

  • ShannonEntropy

    Oh … and I almost forgot, Warrington

    Miriam’s President is paid $1.1 million bucks a year. His boss
    — Lifespan’s CEO — makes $2.9 million

    That money has to come from *somewhere* — and it sure as heck isn’t coming from all the free ER care, labs, surgeries etc etc that the illegal immigrants & assorted homeless bums soak up

    BTW … during my recent Miriam adventure I was billed $1,800 for my CT scan. Medicare paid Miriam just $105 for it … less than six percent of what I would have had to cough up had I been paying the bill myself

    • Warrington Faust

      ” less than six percent of what I would have had to cough up had I been paying the bill myself”

      So, what happened to the other 94%. Did BCBS pick it up? Did it just evaporate?

      • ShannonEntropy

        I guess “evaporate” is as good a description as any … this is the “cost shifting” that Justin is talking about

        A CT scan is done. The Hospital sends a bill. What they actually get paid tho, depends on who is doing the paying

        If you are an illegal immigrant, you just rip up the bill. If you are on Medicare or Medicaid, the hospital *only* gets paid a tiny fraction of the bill. If you are YOU — and paying the bill yer·self — you have to pay the ENTIRE amount billed

        What Gina’s cost-shifting Medicaid Plan will do will be to pay the hospital even less than Medicaid already does

        The hospital will respond to this by jacking up the bill they send to non-insured cash-paying customers like you, to make up the difference

        Miriam’s president couldn’t care less about all this … cuz his seven figure salary won’t be affected

        This is a very complex issue … and why TIME magazine devoted tens of thousands of words laying out the problem

        • Tommy Cranston

          Smoke and mirrors. Like everything else this corrupt, scummy party does.