Too rich to qualify for Medicaid, Too poor to afford health insurance; Guam health care reform bill offers a cure for middle-class pain

July 30, 2017

 

 

 

 

   If you are earning a notch above the federal poverty threshold, you don’t qualify for food stamps, housing assistance, Medicaid or the Medically Indigent Program. You can’t negotiate. As far as the system is concerned, you make too much to receive government aid; you’re good to be on your own. But you know you’re not. Your paycheck is barely enough for your family to get by. You’re stuck in the economic purgatory.

 

   The hardest part, of course, is getting health care. For low to middle income earners, buying health insurance is out of the question.  

 

   “There is a big middle class and working individuals that don’t have insurance because they make one dollar more over the 108 federal poverty level. So even with one dollar, you don’t qualify for Medicaid of MIP. Same with the self-employed or those working for a company that doesn’t offer health insurance,” said Sen. Dennis Rodriguez Jr., chair of the Guam legislature’s health committee.

 

    Guam currently has 32,465 uninsured residents, accounting for 21 percent of the population. The uninsured segment makes up a big bulk of the patient pool being served by the Guam Memorial Hospital. Their inability to pay their hospital bills has resulted in the never-ending financial crisis at GMH, which has been a black hole for government funds.

 

   Giving GMH bandaid treatments has been the government’s default solution. Time and time again, it proves to be an abysmal failure.

 

   “For 40 years, that’s what we have been doing, and every two to three years (hospital officials) come back to the legislature saying the hospital is broke,” Rodriguez said.

 

   The other alternative is raising the hospital rates, which is self-defeating. It only bumps up the amount of the hospital bills that the uninsured cannot afford to pay. 

 

   Rodriguez’s Bill 132, nicknamed Health Care Para Todu Guam, hopes to provide coverage for approximately 15,000 to 16,000 people — those on the cusp between the 108 percent and 200 percent of the federal

 

poverty level— by expanding the Medicaid program. Based on 2013 statistics, the program had 41,706 enrollees.

 

   The proposed Medicaid expansion is not to be mistaken as a health-care for-all plan. Even it succeeds, there would still about 17,000 people who would remain without health insurance coverage.

 

   The proposed health care plan seeks to tap into the remaining balance of the $268 million Medicaid fund that has been made available to Guam under Obama’s Affordable Health Care Act. The Medicaid fund requires a 45 percent local match and must be used up by Sept. 30, 2019.

 

   As of 2017, the Medicaid fund has a balance of $170 million. “So we are putting a plan together to maximize the use of that amount,” Rodriguez said. “If we have a plan in place, there is a real possibility that the allocation to Guam could be extended.”

 

   The bill proposes a three-year pilot program patterned after the government of Guam’s Silver Health Plan. This approach uses  a  combination  of  federal  and  local  Medicaid  dollars  in  addition to employer   and  employee   contributions   to  pay  the  employee's   share  of premiums to employer-offered private health insurance coverage.

 

   The premium contribution rates are designed as follows: 55 percent will come from Medicaid, representing the federal government’s share; 45 will come from the government of Guam’s local matching share, which would be funded through a proposed 4 percent fee to be levied on insurance companies.

   The employer contribution would be equivalent to 65 percent of GovGuam’s premium portion. The employee’s copayment would be equivalent to 2 percent of the employee’s annual income.

 

 

 

   The plan mandates the employee to have a payroll-deducted Health Savings Account, which would provide funds to meet the copayment portion of the plan.

 

   The Silver Health Plan offers incentives in the form of rebate awarded by the insurance company to the employee for participating in heath maintenance programs. “At GovGuam, we have access to the gyms and wellness programs; we get a rebate of $300 a year,” Rodriguez said. 

 

   The employee who takes advantage of the incentive will end up paying zero after earning rebates that would be deposited straight into the health savings account.

 

   “With this plan, you are not holding a Medicaid card; you are holding a TakeCare, Staywell or Netcare card,” Rodriguez said.

 

   This comprehensive plan is based on assumption that the remaining balance of the Medicaid fund — the only component of the Obamacare that applies to Guam — remains intact until its expiration date. As of this writing, the U.S. Senate was getting ready to debate a new divisive healthcare bill that would repeal the Obamacare and is anticipated to result in 22 million fewer Americans having health insurance.

 

   While the Obamacare doesn’t really do anything for Guam, the Medicaid fund is attached to this law. “We are going with the assumption this fund is allocated to Guam and will be there until 2019. Instead of blowing this money, we will invest it into our own people’s health insurance,” Rodriguez said. “That was the only thing that we got from Obamacare. If it will be repealed, I think it will be down the road. And if it will be repealed, it will be replaced with something else. So this is something that is still ongoing.”

 

   The comprehensive healthcare reform also proposes to revamp the Medically Indigent Program, which has a budget of $13 million and currently serves more than 11,000 clients. Under Bill 133, the MIP would be divided into three programs:

 

   -Manelo Care program would mirror the existing program except that the client care system would be converted into a privately managed program;

   - Manelo Plus would expand the MIP eligibility coverage for citizens of freely associated states living on Guam — from households within 100 percent of the federal poverty line to 200 percent of the federal poverty line. The health care service expansion would require financial contributions from FAS governments—Palau, Federated States of Micronesia and Marshall Islands — tapping into their Compact funds. “A lot of times, they return the money (to the feds) because they don’t use it, Rodriguez said.

  -Manaina Care would provide health insurance coverage for senior citizens who are not eligible for Medicare or have needs that are not covered by Medicare.

 

  The two bills produce  a 10-point plan to make healthcare affordable and fix the government hospital without having to impose new taxes. “Unless we fix the root cause, we will never be able to fix the hospital,” Rodriguez said.

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