Sunday, September 29, 2013

The American Healthcare Reform Act



The centuries-old oath taken by health care professionals reads, “Do no harm.”  It is time for Washington lawmakers to take a similar approach when working to fix the problems that exist in our broken health care system.  Simply repealing the President's health care law is not enough—it must be replaced.

Conservatives recognize that patient-centered reforms rooted in free markets are the best way to lower costs and solve problems in our health care system.  That is why the Republican Study Committee (RSC) is proud to bring forward a pragmatic, practical, and portable free-market alternative to the current health care system.  Simply put, our bill is a better way forward. Specifically, H.R. 3121, the RSC's American Health Care Reform Act:
  • Fully repeals President Obama's health care law, eliminating billions in taxes and thousands of pages of unworkable regulations and mandates that are driving up health care costs. 

  • Spurs competition to lower health care costs by allowing Americans to purchase health insurance across state lines and enabling small businesses to pool together and get the same buying power as large corporations.

  • Reforms medical malpractice laws in a commonsense way that limits trial lawyer fees and non-economic damages while maintaining strong protections for patients.

  • Provides tax reform that allows families and individuals to deduct health care costs, just like companies, leveling the playing field and providing all Americans with a standard deduction for health insurance.

  • Expands access to Health Savings Accounts (HSAs), increasing the amount of pre-tax dollars individuals can deposit into portable savings accounts to be used for health care expenses.

  • Safeguards individuals with pre-existing conditions from being discriminated against purchasing health insurance by bolstering state-based high risk pools and extending HIPAA guaranteed availability protections.

  • Protects the unborn by ensuring no federal funding of abortions.

Repeal and Replace Obamacare: It's Time for Reform 


Obamacare is a train-wreck full of broken promises that is increasing health care costs and interfering with the doctor patient relationship. Obamacare must be stopped. We recently sat down with Americans from across the country to ask their opinions of Obamacare and how it is affecting them in the workplace. 

There is a better way to the one-size-fits-all approach of Obamacare. That is why the Republican Study Committee (RSC) isproud to bring forward a pragmatic, practical, and portable free-market alternative to the current health care system without the unworkable taxes and mandates forced on American families through the President’s health care law.
http://rsc.scalise.house.gov/solutions/rsc-betterway.htm  

Tuesday, July 23, 2013

Health Stats: Comparing US to Universal Healthcare



Percentage of men and women who survived a cancer five years after diagnosis: 

            U.S.                    65%
 
            England               46%
 
            Canada                42%
 

Percentage of patients diagnosed with diabetes who received treatment within six months:
 
            U.S.                      93%
 
            England                15%
 
            Canada                43%
 

Percentage of seniors needing hip replacement who received it within six months:
 
            U.S.                      90%
 
            England                15%
 
            Canada                43%
 
 
Percentage referred to a medical specialist who see one within one month:
 
            U.S.                      77%
 
            England                40%
 
            Canada                43%
 
 
Number of MRI scanners (a prime diagnostic tool) per million people:
 
            U.S.                      71
 
            England                14
 
            Canada                18
 
 
Percentage of seniors (65+), with low income, who say they are in "excellent health":
 
            U.S.                    12%
 
            England                2%
 
            Canada                6%
 
 
            And now for the last statistic:
 
 
            National Health Insurance?
 
            U.S.                   NO
 
            England              YES
 
            Canada              YES

*statistics from a survey by the United Nations International Health Organization; published by Investors Business Daily.

Tuesday, July 02, 2013

School Vouchers Equal Better Outcomes for All

from The Platte Institute for Economic Freedom: 7/2/2013

Indiana Leading the Way on Vouchers

In 1875, the Speaker of the House of Representatives James G. Blaine introduced an amendment to the Constitution that would prohibit the use of state funds at private religious schools. While the amendment failed on the national level, 37 states-including Nebraska-adopted these amendments for their state constitutions.[1] While these amendments have long been an impediment to those who support school vouchers-state-sponsored certificates of specified dollar amounts that parents can use for private school tuition[2]-a recent ruling on Indiana's expansive voucher program indicates that vouchers may not fall under Blaine amendment constraints, which would open the door to vouchers in Nebraska.

The Indiana Supreme Court case examined whether Indiana's voucher program, which is available to low and middle-income families, was constitutional. The court held that it was, as the state funds "do not directly benefit religious schools but rather directly benefit lower-income families with school children."[3] Such a precedent could make it possible for other states with Blaine amendments to introduce voucher programs without violating state constitutions, giving parents more choice and control in how their child is educated.

Twelve states currently have voucher programs, but Indiana's is the most expansive. It is a statewide program with a maximum voucher amount of $4,500 for students in grades 1-8.[4] A family of four earning less than $42,000 annually can receive up to 90 percent of the maximum state voucher; families making up to $62,000 annually receive 50 percent.[5] Since its establishment in 2012, participation in the program has grown 140 percent, jumping from 3,919 students to 9,424. In the Indianapolis area in particular, the number of students receiving vouchers increased 94 percent, from 644 to 1,262.[6] Such results demonstrate a critical need for more educational options for students and parents, and Indiana's response is one to be emulated.

Voucher programs introduce choice and competition into education. With vouchers, private schools are no longer open only to those who can afford it, and the playing field is leveled so parents with limited means that want to send their children to private school have opportunities to do so. In addition, a marketplace of educational choice compels both public and private schools to focus on advancing student achievement and meeting parent expectations.[7] Research also suggests that public schools improved when subject to the competition introduced by vouchers. A study of public schools in Florida found "that public schools subject to more competitive pressure from private schools raised their test scores the most following the introduction of Florida's voucher program."[8] Therefore, the positive benefits of vouchers extend even to those who choose to remain in the public school system in some cases.

Voucher programs have shown success in raising student outcomes in their own right. Students in Washington DC's Opportunity Scholarship Program-which provides vouchers to low-income students through a lottery-had a graduation rate of 91 percent, 21 percent higher than those without vouchers. DC voucher students also had higher student achievement and parental satisfaction, even while spending only $7,500 per pupil, while DC public schools spent $29,409 per pupil in 2010.[9] More than 20,000 students in Milwaukee's voucher program also saw positive results, achieving a graduation rate 18 percent higher than their public school counterparts between 2003-2009.[10]

The Indiana court ruling provides Nebraska a unique constitutional opportunity to implement vouchers and give Nebraska parents more opportunities for their children. Every child deserves to have a choice in where they go to school, and it is time to give all of Nebraska's children that choice.

______________________________________________________

[1] Anthony R. Picarello, Jr., School Choice: The Blaine Amendments & Anti-Catholicism, U.S. Commission on Civil Rights, The Becket Fund for Religious Liberty. Accessed June 13, 2013, http://www.usccr.gov/pubs/BlaineReport.pdf; Blaine Amendments, "States." Accessed June 13, 2013, http://www.blaineamendments.org/states/states.html.

[2] Jordan Cash, "Vouchers and Tax Credits," Platte Institute for Economic Research, August 28, 2012. Accessed June 13, 2013, http://www.platteinstitute.org/docLib/20120823_Vouchers_and_Tax_Credits.pdf.
 

[3] Indiana Supreme Court Chief Justice Brent Dickson qtd. in Mark Guarino, "Indiana's expansive school voucher program upheld: A model for others?" Christian Science Monitor, March 26, 2013. Accessed June 13, 2013, http://www.csmonitor.com/USA/Education/2013/0326/Indiana-s-expansive-school-voucher-program-upheld-A-model-for-others.
 

[4] National Conference of State Legislatures, "School Voucher Laws: State-by-State Comparison." Accessed June 13, 2013, http://www.ncsl.org/issues-research/educ/voucher-law-comparison.aspx
 

[5] Indiana Supreme Court Chief Justice Brent Dickson qtd. in Mark Guarino, "Indiana's expansive school voucher program upheld: A model for others?" Christian Science Monitor, March 26, 2013. Accessed June 13, 2013, http://www.csmonitor.com/USA/Education/2013/0326/Indiana-s-expansive-school-voucher-program-upheld-A-model-for-others.
 

[6] Indiana Supreme Court Chief Justice Brent Dickson qtd. in Mark Guarino, "Indiana's expansive school voucher program upheld: A model for others?" Christian Science Monitor, March 26, 2013. Accessed June 13, 2013, http://www.csmonitor.com/USA/Education/2013/0326/Indiana-s-expansive-school-voucher-program-upheld-A-model-for-others.
 

[7] David N. Figlio and Cassandra M.D. Hart, "Competitive Effects of Means-Tested School Vouchers," National Bureau of Economic Research, Working Paper No. 16056, June 2010. Accessed June 13, 2013, http://www.nber.org/papers/w16056.pdf.
 

[8] David N. Figlio and Cassandra M.D. Hart, "Competitive Effects of Means-Tested School Vouchers," National Bureau of Economic Research, Working Paper No. 16056, June 2010. Accessed June 13, 2013, http://www.nber.org/papers/w16056.pdf.
 

[9] Jason Richwine, "D.C. Voucher Students: Higher Graduation Rates and Other Positice Outcomes," Heritage Foundation, July 28, 2010. Accessed June 13, 2013,
http://www.heritage.org/research/reports/2010/07/dc-voucher-students-higher-graduation-rates-and-other-positive-outcomes; Patrick Wolf et al., "Evaluation of the DC Opportunity Scholarship Program: Final Report," United States Department of Education, June 2010. Accessed June 13, 2013,
http://ies.ed.gov/ncee/pubs/20104018/pdf/20104018.pdf; Andrew Coulson, "Census Bureau Confirms: DC Spends $29,409/pupil," Cato Institute, June 26, 2012. Accessed June 13, 2013,
http://www.cato.org/blog/census-bureau-confirms-dc-spends-29409-pupil.
 

[10] John Robert Warrem, "Graduation Rates for Choice and Public School Students in Milwaukee, 2003-2009," University of Minnesota, School Choice Wisconsin, January 2011. Accessed June 13, 2013,
http://heartland.org/sites/all/modules/custom/heartland_migration/files/pdfs/29370.pdf.


Increasing Legal Immigration is the Answer



This afternoon the Senate voted 68-32 to pass its sweeping immigration reform bill. The bill is a solid improvement over the current immigration system. It legalizes most of the unlawful immigrants here and provides larger pathways for legal immigration in the future.
Under today’s immigration rules, very few of our ancestors would have been able to immigrate here legally. 
The bill does have flaws – many of which I’ve written about in detail. It doesn’t increase lawful immigration enough. The guest worker visa programs for lower skilled workers are too small, restricted to certain sectors of the economy, and governed by confusing bureaucracy. Under today’s immigration rules, very few of our ancestors would have been able to immigrate here legally. The Senate’s immigration bill takes us a small step closer to our traditionally more open immigration policy.

It shovels gargantuan amounts of security resources toward the southern border in an attempt to halt future unlawful immigration that could otherwise cheaply be halted with an expanded guest worker visa program. The border “surge,” as many are calling it, is truly embarrassing, especially for a country with such proud immigrant traditions. There are certainly legitimate security concerns, but the extra enforcement will just drive up the price of smuggling and marginally decrease unlawful immigration of peaceful workers at enormous cost.

Worse, the bill creates a mandatory employment verification system called E-Verify. Those seeking work here will have to use this proto-national ID system to ask the government for permission to work. Government audits of the system find that its inaccuracy rate hovers at around a quarter of a percent. Independent audits, the most recent carried out in 2009, found error rates 3 to 4 times as high as that. As the system is expanded it will place an unfair burden on American businesses, saddling them with costs, and incentivizing illegal hiring without even a cursory I-9 form as has happened in states that have already mandated E-Verify.

Even with those flaws, this bill still does a lot more good than bad. Millions of new Americans will finally be able to live and work openly without fear of deportation. Millions of more highly skilled workers, merit-based immigrants, and their families will be able to become Americans. Americans will have more freedom to hire whom they want and more buyers for their goods and services. Our economy will grow more quickly, wages will increase, and the fiscal state of the federal government will improve over the medium-term.

Despite all of these benefits, this bill will face an uphill battle in the House of Representatives. The first round of a major political brawl has been concluded; time for the toughest round to begin.


http://www.cato.org/blog/immigration-bill-better-not-best?utm_content=bufferb6f2c&utm_source=buffer&utm_medium=twitter&utm_campaign=Buffer

Monday, June 17, 2013

Step-By-Step Immigration Reform

By Bryan Baumgart-Douglas County Republican Party Chairman

6/17/2013

Critics of immigration reform call for securing our borders first, but with effective reform, securing our borders on the basis of immigration isn’t necessary.

Rather than a comprehensive approach, I prefer a step-by-step approach to reform with an emphasis on “risk verse reward”…or as we like to call it in the field of behavior modification…“Principles of Behavior”. Our solutions should be incentive based.

First let’s analyse what is driving current behavior.  What is the incentive to bypass the legal immigration process?  As we know, the current system is extremely convoluted and expensive. It takes far too long and is rife with unintended consequences.

For example, a friend and former co-worker of mine from Brazil had spent years and thousands of dollars working through the system. When he was approached with an outstanding job opportunity with a different company, he was faced with the decision of turning down the offer or starting the immigration process all over again. In the end, he felt like it was just too much time and money to throw away. He was left stuck, extremely frustrated, and he lost out on a great opportunity to advance his career.

The first step in effective reform must be simplifying the legal immigration process. This is likely the most difficult step, but a legal immigration process that is affordable, timely, and efficient serves as an incentive rather than a deterrent.

The next question is what becomes of the 11 million undocumented immigrants currently in our country? Critics decry amnesty, but deportation is not a realistic option and neither is tearing families apart over a misdemeanor. Continuing to ignore their presence has proven to be a mistake. The people screaming, “No Amnesty” are the very same people upset about footing the bill. It’s a consequence of refusing participation in the system.

The only realistic option is to offer a pathway to citizenship. Not granting instant citizenship, but allowing undocumented immigrants to self-report and enter the now simplified legal immigration process just like everyone else. Providing a temporary work or school visa allows families to stay together while they work through the immigration process. Paying taxes, obtaining insurance and healthcare, and legally participating in the system helps to empower these hard working families and encourages them to buy into the American Dream. Being welcomed and becoming part of the system provides the incentive to assimilate and proudly view oneself as American.

The next step, indexing visas to meet the economic demand of the country. As a country that has thrived on capitalism, it only makes sense to allow legal immigration to meet the labor demands of American businesses. When these businesses are allowed to thrive, so does our country. They create more jobs and provide more revenue.

The final step is much easier. Effectively implementing E-Verify measures by cracking down on employers with strict penalties. The incentive for employers to seek cheaper labor is a reality we must face. It is an unintended consequence of government interference in the market with the implementation of minimum-wage laws. Indexing visas to ensure labor supply meets demand is a good start, but until the risk outweighs the reward, don’t expect employers to voluntarily comply with the law. Once employers do comply, the lack of job opportunities available to undocumented immigrants serve as an incentive to self-report and enter the now much simpler legal pathway to citizenship.

Finally, to be clear on securing our borders. I do favor securing BOTH of our borders, but on the grounds of national security, not immigration. Without the incentive for illegal immigration, securing our borders is not necessary. The only people who would be interested in sneaking across our borders would be the people who mean us harm. Thus…it’s an issue of national security.

http://www.politicalinsidersreport.com/2013/06/17/step-by-step-immigration-reform/

"Under today’s immigration rules, very few of our ancestors would have been able to immigrate here legally." - CATO Institute

http://www.cato.org/blog/immigration-bill-better-not-best?utm_content=bufferb6f2c&utm_source=buffer&utm_medium=twitter&utm_campaign=Buffer


Friday, June 14, 2013

Broaden Immigration Reform Beyond Enforcement

Monday, April 22, 2013

Common Core - Dangerous for America!




 Nebraska Taxpayers for Freedom Issue Paper: commoncore1.doc.  4-13.

BACKGROUND.  Conservatives are legitimately alarmed about the Obama Administration Common Core curriculum pressed onto our public schools.  The regime heavily pushes this curricula through its $4.35 billion 2009 Race to the Top education grant competition bribery.  Many states have embraced Common Core to grab these massive grants.  States that accepted its precepts received bonus points in their applications.  This plan awards points to states that adopt this common set of K-12 standards that are mostly identical all over America. Obama’s Education Dept. has awarded over $360 million to 2 liberal groups to create student assessments in Common Core.  Obama herded states into adopting these standards without time to deliberate on their adequacy, requiring adoption approved by state education dept. officials, if states want to obtain federal waivers from the 2002 No Child Left Behind law.  If Obama succeeds, states like NE will lose federal funds by adhering to their own standards, denied access to Race to the Top federal dollars for refusing Common Core.
  
VALID CRITICISM.  Common Core eradicates local school board control over the K-12 math and English curricula, substituting a lone, federally-imposed curricula that applies to public, private, parochial, and home schools.  Proponents advise that national standards will improve academic performance; however, these new standards evidence no proof that they are better than current NE standards.  No district has tested these standards, which use unproved instructional methods. These standards base on unproved ideas and questionable assumptions.  The job of teaching our kids is too important to depend on untested, common methods pushed by companies that have financial interests in selling textbooks, technology, and academic assessment but not accountable to parents or taxpayers. Several private corporations will make huge profits, with less money reaching classrooms.  Our children will become guinea pigs.  In Massachusetts, adopting Common Core meant dumping academic standards regarded as the best in the nation.  In many states, Common Core standards are inferior to state standards.  There exists no evidence that a federal curriculum brings high academic achievement.  France and Denmark boast national curricula that do not reflect high achievement on international testing.  Contrarily, both Canada and Australia use many regional curricula and show better results.[1]  A Brookings Institution study found that common state standards do little to equalize academic achievement among states.[2]   Instruction is confusing.  Common Core requires pupils to explain a math problem before doing the calculation, complicating the teaching of basic math.  Teachers become confused with the unfamiliarity of teaching this product.  Students do not learn traditional math, like multiplication, until a grade or two later. In Common Core math, kids abandon concrete skills for abstract confusing methodology.  Elementary kids who got “A” grades struggle to explain how they find answers after using mental math in Common Core and get lower grades.  These math standards delay development of key concepts and skills, instructions written at a level confusing to teachers, students, parents, and administrators.  Math standards not well-organized at the high school level, several important topics insufficiently covered, and standards not divided into defined courses. To avoid attention, proponents have focused only on math and English, aiming to eventually extend Common Core to all subjects.  Math standards are inferior.  A math professor, the only mathematician on the validation committee, refused to sign off on the math standards, declaring that they would drop many pupils 2 yrs. behind those in many other nations.  One most tragic change for English classes is the requirement that 50% or more of readings in Grades 6-12 come from informational instead of cultural texts.  Such means that curricula will not include many classic works in American and other literature.  Popular treatises like Common Sense, the Gettysburg Address, and To Kill A Mockingbird are not present, only on a list of reading suggestions.  No research tells that college readiness comes from reading informational items in high school classes.[3]  Conservatives around the country are angry about the secretive process by which Common Core standards became adopted, allowing for few or no public hearings, blocked from the legislative process.  The conservative Cato Institute noted that state lawmakers are surprised when academic curricula become snatched from their prerogatives.  Common Core defines contents for all U.S. K-12 math and English texts and defines what our kids will learn and not learn.  No empirical validation of standards or metric to monitor intended or unintended consequences.  No early childhood teachers or child development experts were included in the K-3 standards formulation process, because Common Core shocked these professionals.  Standard writers had no background in child development or early childhood education.  The Joint Statement of Early Childhood Health & Education Professionals statement criticizing Common Core garnered signatures from over 500 prominent early childhood professionals, like educators, pediatricians, developmental psychologists, and researchers.  The statement read that Common Core conflicts with new research in cognitive science, neuroscience, child development, and early childhood education about how young kids learn, what content they should learn, and the best methods to teach them in kiddiegarden and early grades.  Common Core pilots are disappointing.  One principal told of his school piloting the assessment, whereby the failure rate rose dramatically, particularly among slow learners. 

COMMON CORE TESTING.  After adoption of Common Core curricula, its standardized testing is approaching fast.  No national standardized test can effectively measure what teachers teach in each public school system.  Common Core demands a great increase in testing, much more than the already excessive amount required by No Child Left Behind.  NYC will spend over a half billion on technology, so that its students can take electronically federal tests.  Research proves that increasing testing does not increase achievement.  NE school districts suffer funding squeezes, but Common Core costs billions for new textbooks, infrastructure like high speed networks, new software for additional computers, training, consultants, and tests. 

COST TO TAXPAYERS.  Adoption is expensive, and states adopting Common Core jump into an assessment quagmire without estimates on costs.  Local school administrators complain that Obama grants do not cover the requirements, costing much more to implement all the mandates.  The education establishment likewise complained for years about the unexpected costs of No Child Left Behind.  Common Core will repeat this expensive lesson in forcing another underfunded ed mandate on states.  NE probably would not qualify for federal funding now, leaving NE taxpayers to pay the entire bill. 

LEFTIST CURRICULA.  One lesson features a video titled China Rises, that praises the virtues of Chinese communism over capitalism.  The leftist New York Times co-produced this propaganda piece.  Another lesson regrets children inability to vote, as they understand global warming and war better than adults who make world problems worse.  Common Core uses UN programs to institute international curricula. Materials promote “alternative lifestyles,” criticize capitalism, praise labor unions, redistribution of wealth, radical environmentalism, and social justice, and debase of Judeo-Christianity. The liberal progressive school-to-work plan will allow the Obama Regime to put everything in place to plan for future labor markets.  Common Core promotes a model of a command economy and unlimited federal governance.  Proponents want to control our schools, so that our children will become conditioned to accept that the federal government has the right to order them to serve its economic commands.  Government will be the master, not the servant. 

ITS FUNDING.  Common Core has received funding from the Bill & Melinda Gates Foundation and other leftwing sources. 


ITS SUPPORTERS.  The leftwing American Federation of Teachers (AFT) endorses Common Core. Several creators of  Common Core standards have accepted employment with testing companies that will accrue millions of dollars developing tests based on the standards they created.

HOME SCHOOLS UNSAFE.  Saxon Math and Math U See both declared that they will align their curriculum, popular among home schools, with Common Core.

INVASIVENESS.  Conservative parents object to violation of student privacy by data mining through assessment means. Common Core creates a student database including test scores, hobbies, family income, voting status, and health records, a violation of individual rights and limited government. [4]  Data mining includes using cameras to evaluate kid facial expressions, electronic seat that judges postures, a pressure-sensitive computer mouse, and a biometric wrap on wrists.

STATE BOARD OF EDUCATION.  Board members voted 7-1 (John Sieler voted with taxpayers) to pay a consultant company $47,000 to compare NE standards alignment to Common Core, due in October, 2013, a hint that the board majority will embrace the latter curricula.  The State Board of Education must give final approval of state curriculum standards and assessments. School districts should not use Common Core yet, as the state board has not adopted it yet.  We urge taxpayers to contact their state board of education member to pass the following resolution:
 
Notwithstanding any other statute, the state board of education shall not adopt, and the NE Dept. of Education shall not implement, Common Core standards developed by the Common Core Standards Initiative.  Actions pursued to adopt or implement the Common Core State Standards are void.  Common Core State Standards shall not be adopted or implemented without the approval of the NE Legislature.

LEGISLATURE.  Sen. Jim Scheer from Norfolk introduced LB 512, to order the state to accept Common Core national assessments and allow the state board of education to proceed with this curricula. We must lobby our state senators to kill LB 512, then co-sponsor and support legislation to ban NE from adopting and spending money on all activities relating to Common Core, like training teachers or buying materials.  Also, press them to pass a bill to forbid sharing of private student information without parental consent.   

CONSTITUTIONAL ISSUE.  As awareness of this federal education power grab increases, opposition mounts.  States now realize that accepting Common Core means transferring control of school curriculum to the Obama Regime.  Only Texas, Alaska, Nebraska, and a few other states are steadfastly resisting, and others have withdrawn participation or are considering such.  Common Core violates the U.S. Constitution and several federal statutes that prohibit federal direction, control, or supervision of curricula, instruction, and materials in K-12 schools.  This plan is a serious assault on state sovereignty, a power grab by which the Obama Regime will directly target school districts.  This federal intervention will cripple state, local, and parental authority over curricula and cost states $16 billion in new spending.[5] 

TAKE ACTION NOW.  We still can stop this dangerous scheme to nationalize education and indoctrinate our children.  Do not permit nameless, faceless, unelected and unaccountable bureaucrats to seize control of NE public education.  Contact your state board of education member and state senator today to stop the progress of Common Core in Nebraska.  Email netaxpayers@gmail.com for their contact information. 
Research, analysis, and documentation for this issue paper done by Nebraska Taxpayers for Freedom, with prior permission granted for its use by other groups in the NE Conservative Coalition Network.  4-13.   C

[1] Closing the Door on Innovation: Why One National Curriculum is Bad for America. Available at: http://www.k12innovation.com/Manifesto/_V2_Home.html.
[2] “The 2012 Brown Center Report on American Education: HOW WELL ARE AMERICAN STUDENTS LEARNING?
[3] Common Core Standards, Devastating Impact on Literary Study and Analytical Thinking, Sandra Stotsky, Heritage Issue Brief, Heritage Foundation, December 2012.
[4] Joy Pullmann, managing editor of School Reform News and an education research fellow at the Heartland Institute.
[5] Heritage Foundation. 

Thursday, April 11, 2013

Medicaid Patients Have Worse Access and Outcomes than the Privately Insured


Abstract: Academic literature has consistently illustrated that Medicaid patients—adults and children—have inferior access to health care, and notably poorer health outcomes, than privately insured patients. Due to the program's low reimbursement rates, more and more doctors are refusing to even accept Medicaid. As a result, it is becoming increasingly difficult for Medicaid patients to find access to primary and specialty care physicians. When Medicaid patients are admitted to hospitals, they are often admitted with more serious conditions than those with private insurance. By further expanding this broken program, Obamacare will only exacerbate the situation, continuing to harm many low-income Americans who have no option other than Medicaid. Policymakers should reform Medicaid to allow Medicaid patients access to private insurance in a consumer-driven market.

Established as a fundamental component of President Lyndon Johnson's Great Society, Medicaid is a jointly funded federal and state program that pays for health care for low-income individuals. The academic literature has consistently illustrated that Medicaid patients have poorer access to care, and poorer health outcomes, than privately insured patients. By further expanding this broken program, the Patient Protection and Affordable Care Act - Obamacare - only exacerbates the situation. Policymakers should reform Medicaid to provide consumers with greater access to private insurance in a consumer-driven market.

Medicaid typically pays physicians 56 percent of the amount that private insurers pay.[1] Given these low reimbursement rates, more and more doctors are refusing to accept Medicaid.[2] As a result, it is becoming increasingly difficult for Medicaid patients to find primary care doctors and specialists. When Medicaid patients are admitted to hospitals, they are often admitted with more serious conditions, and in some cases, with a higher level of co-morbidity, than privately insured patients. The peer-reviewed academic literature clearly illustrates Medicaid's problems for children as well as for adults.

Children Suffer Under Medicaid

Medicaid undermines care for millions of children. Consider, for example, children with asthma, one of the most common chronic diseases affecting children in the United States. A 2001 study published in the Journal of Health Care for the Poor and Underserved compares hospital care for children with asthma who are covered by Medicaid to children with asthma who are covered by private insurance in California, Georgia, and Michigan.[3] The authors found slightly longer length of stay and significantly poorer outpatient care for the children on Medicaid. In terms of outpatient care, the authors specifically found that pediatric Medicaid patients were more likely than privately insured patients to be discharged on subpar medication routines. The authors also found that Medicaid patients generally lacked a consistent source of outpatient care, unlike privately insured patients. These issues with outpatient care suggest that these children are more likely to be re-admitted for hospitalization at a subsequent time in the future.

Adequate access to care is also a serious problem for children on Medicaid. A 2004 study published in Pediatrics examined children’s access to specialty surgeons in Southern California.[4] The researchers surveyed specialty surgeons throughout southern California and found that the surgeons are generally less inclined to accept patients enrolled in Medi-Cal (California’s version of the Medicaid program). The surgeons cited difficult paperwork, administrative burdens, and poor reimbursement rates as reasons for not wanting to take on these patients. The authors consequently caution policymakers about expanding this program, noting that coverage through Medi-Cal does not necessarily signify meaningful access to health care. The authors also suggest that expanding Medi-Cal may in fact exacerbate the existing problems of limited access to care.

Another study published in 2005 in Urology found similar problems with boys’ access to urologic care.[5] The authors surveyed a simple random sample of urologic offices located throughout California in order to determine the offices’ attitudes toward Medi-Cal recipients. Of the offices they found that were willing to see pediatric patients, the authors found that 96 percent of these offices would accept privately insured patients. They also found that only 41 percent of these offices would accept Medi-Cal patients. Three-quarters of the offices that refused to accept Medi-Cal patients were unable to even recommend offices that would.

Furthermore, a recent study published in the New England Journal of Medicine examined pediatric access to specialty clinics in Cook County, Illinois.[6] Sending out research assistants posing as mothers and making phone calls to a random sample of specialty clinics, the study found a significant disparity between access to specialty care for privately insured children and children on Medicaid as well as the publicly funded Children’s Health Insurance Program (CHIP). Specifically, the researchers noted more denials of appointments as well as longer waiting times for Medicaid and CHIP patients than for privately insured patients.

These studies suggest that children on Medicaid lack access to the kind of care that privately insured patients enjoy. As long as the program in its current form remains in place, these problems will persist.

Adults Suffer Under Medicaid

Children are not the only ones Medicaid is failing. A number of academic studies have also pointed out the disparities in health outcomes between adult Medicaid recipients and those who are privately insured.

A 1993 study published in the New England Journal of Medicine found that breast cancer patients in New Jersey were often diagnosed with more advanced stages of the disease and had higher risks of death if they received their insurance coverage through Medicaid instead of private insurance.[7] These findings have been corroborated by a number of subsequent studies looking at a variety of serious illnesses:
  • A 2000 study published in Cancer examined health outcomes of breast cancer patients in Florida. The study found that, as a result of later diagnoses, Medicaid patients have higher mortality rates than patients who are covered by commercial fee-for-service insurance.[8]
  • A 2000 study published in the American Journal of Public Health that examines colorectal cancer treatments and outcomes found that Medicaid patients not only had higher mortality rates, but were also less likely to receive cancer-directed surgery, than patients using commercial fee-for-service insurance.[9]
  • A 2001 study published in Cancer compared health outcomes for a variety of cancers for patients in Michigan. The study found that Medicaid patients had significantly higher rates of occurrence as well as higher risks of death for breast, cervix, colon, and lung cancers compared to non-Medicaid patients. The study also found that Medicaid patients had a higher risk of being diagnosed with these cancers at later stages.[10]
  • A 2003 study published in the Archives of Internal Medicine that compares health outcomes for colorectal, lung, prostate, and breast cancer in Kentucky for a variety of insurance classifications also found similar results. For all four illnesses, the authors found that survival rates are markedly higher for privately insured patients than for Medicaid patients.[11]
Most recently, a 2010 study in the Journal of Hospital Medicine found similar results for non-cancer-related illness. In this study, the authors examine the relationship between insurance status and health outcomes for myocardial infarction, stroke, and pneumonia patients.[12] The authors statistically analyzed a nationally representative hospital database and noticed, even after adjusting for factors such as age, gender, income, other illnesses, and severity, higher in-hospital mortality rates for Medicaid patients than for privately insured patients. Additionally, even after adjusting for these factors, the study found that Medicaid patients hospitalized for strokes and pneumonia also ran up higher costs than the privately insured, as well as the uninsured.

Medicaid: Hinders Access to Care, Fails to Meet Patients’ Needs

A number of academic studies over the years have illustrated that Medicaid patients have consistently had poor access to care and that Medicaid fails to meet important needs:
  • A 1992 study in the Journal of the American Medical Association examined hospitalizations in Massachusetts and Maryland.[13] The study found that Medicaid and uninsured patients were statistically more likely than privately insured patients to be hospitalized for avoidable conditions such as pneumonia and diabetes.
  • A 2007 study in Health Affairs examined access to specialty services for patients who receive primary care from community health centers.[14] The study found that Medicaid recipients have significantly more difficulty accessing specialty care than privately insured patients.
  • A 2012 study in Health Affairs examined physicians’ willingness to accept new patients. Using survey data from a nationally representative sample, the study found that nearly one-third of physicians nationwide will not accept new Medicaid patients. Doctors in smaller practices, as well as doctors in metropolitan areas, are among the least inclined to accept new Medicaid patients.[15] The authors’ results suggest that this reluctance may largely be a consequence of Medicaid’s poor payment rates to doctors.
Given these findings in the peer-reviewed literature, it is not surprising that Medicaid patients often arrive at emergency rooms in poor, and in many cases, untreatable condition. In fact, research has shown that Medicaid and CHIP patients end up in emergency rooms even more frequently than uninsured patients.[16]

Solutions

As the academic research has consistently suggested, Medicaid’s so-called safety net cripples the very people it is designed to help. To fix the broken safety net, Congress should consider the following.[17]
  • Repeal Obamacare and its Medicaid expansion. One of Obamacare’s greatest pretenses is that it improves access to health care. The new law attempts to achieve this goal by dumping millions more patients into the broken Medicaid system. Recent Heritage Foundation research has statistically illustrated the debilitating effect that Medicaid expansion will impose on state governments.[18]
Some proponents will likely argue that Obamacare addresses access issues by providing additional federal funding to increase physician reimbursement to Medicare levels. However, this additional federal reimbursement is only temporary and solely applies to primary care physicians. As a result, it is only a matter of time until state budgets become more burdened and a lack of access to meaningful health care becomes even more of a problem nationwide.[19]
  • Maximize access to private health insurance for Medicaid beneficiaries. The best approach to improving access and outcomes would be to integrate the success of private health insurance into the Medicaid system. Some states, such as Florida, have pursued reforms in the past decade by giving Medicaid patients a choice of private managed care plans. A five-county pilot version of the program flattened Medicaid costs and had been saving the state slightly under $120 million annually. Additionally, the program overall noted greater access to care, higher degrees of patient satisfaction, and a marked improvement in health outcomes.[20]
The Heritage Foundation’s Saving the American Dream proposal goes further. It recommends transitioning non-disabled Medicaid beneficiaries out of the failing Medicaid program and into private health insurance and integrating private, patient-centered models into Medicaid to better serve the disabled and frail elderly.[21]

Conclusion

Medicaid is a prime example of government’s inability to outperform—or even keep up with—the private sector. Academic research has consistently illustrated that the program is associated with poorer access to care and poorer health outcomes than private insurance. With the right reforms, however, lawmakers can significantly expand Medicaid patients’ access to private health insurance and put low-cost, high-quality care back in the hands of those truly in need.

—Kevin D. Dayaratna is Graduate Fellow in the Center for Health Care Policy Studies at The Heritage Foundation.

http://www.heritage.org/research/reports/2012/11/studies-show-medicaid-patients-have-worse-access-and-outcomes-than-the-privately-insured

Saturday, March 16, 2013

Critics Proved Wrong Again on Voter ID


By Hans A. von Spakovsky - December 19, 2012

Kris Kobach, the secretary of state of Kansas, has released some very interesting statistics that disprove — once again — the fallacious claims made by critics of voter ID. Kansas, whose voter-ID law became effective this year, has 1.8 million registered voters. From January 1 through September 30, only 120 people in the entire state applied for the free ID that Kansas provides to anyone who doesn’t already have a photo ID.

Those 120 constitute only 0.007 percent of all voters registered in Kansas.

On Election Day, only 0.07 percent of the 1,182,771 Kansans turning out at the polls were unable to show a proper form of identification. They were allowed to cast provisional ballots and told to present a valid ID after the election so that their vote would be counted. Almost half of the provisional voters did so, dropping the number of voters without proper ID to just 0.04 percent of all people who tried to cast votes.

These figures give the lie to claims by the Brennan Center and other voter ID opponents that a whopping 11 percent of voting-age Americans have no acceptable form of photo ID, and that voter-ID laws therefore present a hindrance for many.

In an election where turnout across the country generally went down from 2008, Kansas had a turnout of 66.8 percent. That’s virtually the same as the turnout in 2000 (66.7 percent) — the last presidential election year in which Kansas had no U.S. Senate race.  Sorry, Brennan Center. Your claim that voter ID laws reduce turnout goes up in smoke. Again.

http://www.nationalreview.com/corner/336110/critics-proved-wrong-again-voter-id-hans-von-spakovsky

Thursday, March 14, 2013

The Final Strike to Obamacare


March 7, 2013

by: Bryan Baumgart

The death of Obamacare was prolonged Wednesday when Congress approved legislation to fund the government through the 2013 Fiscal Year. By settling for minor cuts to spending, Republican House leadership effectively allowed the opportunity to end Obamacare to slip through their hands.
  
In January, hoping to buy time to shore up Obamacare's Achilles Heel, the Obama administration waived the deadline for states to establish exchanges.

When Rep. Nancy Pelosi stated, "We will have to pass it [Obamacare] to see what is in it", she had no idea the fatal flaw she was ignoring. Obamacare was crafted in such a way, that its funding is completely dependent on the states to establish exchanges. If a state refuses to set up an exchange, and so far 25 have refused, the federal government must step in and create one. However, the law does not authorize tax credits and subsidies to flow through federally created exchanges, only those created by states. Furthermore, there is reason to doubt that the federal government has either the ability or the money to implement the exchanges themselves. To date, congress has not appropriated any funding for this purpose. Unfortunately, today marked a missed opportunity for Republican leadership to take advantage of this flaw.

Fortunately, we have one last opportunity to get it right, before Obamacare takes full and irreversible effect in 2014. Current government funding expires on September 30, 2013. Congress will be under immense pressure to pass a budget or another continuing resolution (CR) to avoid a government shutdown. This will be our one and final chance to take down Obamacare. Conservatives must stick together and refuse to approve any budget or CR that does not completely defund Obamacare (including the exchanges, Medicaid expansion, etc.). It would also be an appropriate time to repeal the attack on religious liberty.

Now is the time to see what kind of political courage our Republican leadership has. We have heard plenty of rhetoric surrounding priorities and promises to take Obamacare down. Will our leaders walk the walk, or just keep talking?

(Note: Any attempt to unilaterally rewrite the law to fix these flaws would certainly end up before the Supreme Court. Perhaps next time they will get it right.)

If you do only ONE thing to help your country this year, I encourage you to contact your reps and demand that they do not pass a CR that does not sufficiently defund Obamacare and all of its provisions.

Congressman Lee Terry:
11717 Burt Street, Suite 106
Omaha, NE 68154 
Phone: (402) 397-9944
Fax: (402) 397-8787

Congressman Jeff Fortenberry:
301 South 13th Street, Suite 100
Lincoln, NE 68508
p (402) 438-1598
t  (866) 725-5255
f  (402) 438-1604

Congressman Adrian Smith:
1811 West Second Street, Suite 275
Grand Island, NE 68803
Phone: (308) 384-3900
Fax: (308) 384-3902

Senator Deb Fischer:
P.O. Box 83287
Lincoln, NE 68501
Phone: 402-742-0084

Senator Mike Johanns:
9900 Nicholas St., Suite 325
Omaha, NE 68114
Tel: (402) 758-8981
Fax: (402) 758-9165