Bush Administration Escalates War Against Middle Income Children’s Health Insurance (UPDATED)

“You have to wonder how many people who gave President George Bush the benefit of the doubt in 2000 and 2004, or Ralph Nader voters who truly felt there as “no difference” between the two parties will react to this:

The Bush administration, continuing its fight to stop states from expanding the popular Children’s Health Insurance Program, has adopted new standards that would make it much more difficult for New York, California and others to extend coverage to children in middle-income families.

Administration officials outlined the new standards in a letter sent to state health officials on Friday evening, in the middle of a month-long Congressional recess.

So once again, the administration is in effect moving to ignore the wishes of Congress as if the executive branch is the entire goverment. MORE:

In interviews, they said the changes were aimed at returning the Children’s Health Insurance Program to its original focus on low-income children and to make sure the program did not become a substitute for private health coverage.

After learning of the new policy, some state officials said today that it could cripple their efforts to cover more children by imposing standards that could not be met.

We have said it several times before and some folks get mad and start the “how can you call yourself a moderate” mantra. But we’ll say it again:

You almost can’t be a moderate anymore and be silent as you read this New York Times piece, only the LATEST in a seemingly endless series of Bush Administration Outrage Stories Of The Day that are increasingly defended by the administration’s rapidly shrinking number of lockstep supporters. The Bush administration is not a “conservative” administration — but an increasingly radical one.

Keep in mind that this story is surfacing as some GOPers continue to talk about the need for tax cuts.

Here’s a key quote from an AP story:

The new guidelines could have a dramatic impact on those states as well as any other that wanted to follow in their steps, said Cindy Mann, executive director of the Georgetown University Center for Children and Families.

“It’s a pretty radical departure in policy that has been in existence for 10 years,” Mann said. “It attempts to stop in their tracks those states that have already or want to expand coverage.”

So this is no longer matter of the administration just battling a Congressional move to EXPAND this plan.

This is a matter of the administration TAKING AWAY part of this plan from states that already offer coverage go some kids. (I personally know of a 12 year old girl here in California who just learned she has a bad kidney. She is insured by the same insurance GWB is now trying to eliminate.).

PREDICTION:
A lot of voters will cast protest votes in 2008. Hopefully, many Republicans will as well since the Republican party needs to “clean house” and get some new leadership.

And mark this day on your calender:

The administration’s action taken during a Congressional recess represents the the FINAL NAIL in the coffin of the claim of “compassionate conservatism.” The Times again:

Ann Clemency Kohler, deputy commissioner of human services in New Jersey, said: “We are horrified at the new federal policy. It will cause havoc with our program and could jeopardize coverage for thousands of children.”

Stan Rosenstein, the Medicaid director in California, said the federal policy was “highly restrictive, much more restrictive than what we want to do.”

The poverty level for a family of four is $20,650 in annual income. New York now covers children in families with income up to 250 percent of the poverty level. The State Legislature has passed a bill that would raise the limit to 400 percent of the poverty level — $82,600 for a family of four — but the change is subject to federal approval.

California wants to increase its income limit to 300 percent of the poverty level, from 250 percent. Pennsylvania recently raised its limit to 300 percent, from 200 percent. New Jersey has had a limit of 350 percent for more than five years.

We’ve just posted this post so we can’t say “we’re speechless.”

And we’re sure Rush and Sean will have something to say about going after kids’ insurance benefits….most likely praising the administration’s move as they get ready to board their rented private jets after their broadcasts.

And we suspect a lot of voters (and parents and relatives of sick kids) will have lots to say in 2008.

UPDATE: Some additional news stories of interest. These are excerpts so click on the link to read entire piece (we recommend them).
Wall Street Journal: White House Moves to Limit Health-Insurance Program

The Bush administration, after years of allowing states to cover more children from higher-income families through a popular state-federal health-insurance program, is putting the brakes on expansion.

The policy change will affect states that seek to or already cover children from families with income at 250% of the federal poverty level, or $51,625 for a family of four. (The federal poverty level is $20,650 for a family of four.) At least 16 states had received permission over the years to expand to or beyond that level.

The step will also put the administration on a collision course with Congress, which has approved legislation with tens of billions of dollars to expand the program to cover more children. The House and the Senate are expected to work out a compromise after the August recess.

–An ohio-oriented piece from the AP has this:

The latest political football, one that could be tossed deep into next fall’s elections, is an American child without health insurance…..

….”It was a very non-controversial issue that has become very controversial because the president and a group of very conservative Republicans have decided to make this some kind of wedge issue,” said Robert Blendon, professor of health policy and political analysis at Harvard University’s Kennedy School of Government.

Simply put, it’s tough for any politician to overcome being portrayed as voting against kids.

–The Reuters report contains this:

The letter from Dennis Smith, the director of the federal Center for Medicaid and State Operations, set a high standard for states that want to raise eligibility for the program above 250 percent of the poverty level, the Times said.

Before making such a change, Smith said, states must demonstrate that they have “enrolled at least 95 percent of children in the state below 200 percent of the federal poverty level” who are eligible for either Medicaid or the child health program, the newspaper said.

Administration officials said the changes were aimed at returning the focus to low-income children and to make sure the program did not become a substitute for private health coverage, the Times said.

Deborah Bachrach, a deputy commissioner in the New York State Health Department told the paper: “No state in the nation has a participation rate of 95 percent.”

California wants to increase its income limit to 300 percent of the poverty level, from 250 percent. Pennsylvania recently raised its limit to 300 percent, from 200 percent. The New York state legislature recently passed a bill that would increase its income limit to 400 percent of the poverty level, up from 250 percent, according to the newspaper.

The Washington Post provides this perspective:

The administrative move, announced while lawmakers are out of town during the August recess, comes after the White House has wrangled with Congress for months over the future of the $5 billion-a-year program.

The Senate and the House have passed legislation that would dramatically increase funding and make it possible to sign up millions of new children for coverage. But President Bush wants to keep the program largely unchanged and has promised to veto either bill, saying they would inappropriately increase the federal role in health care.

SCHIP was created in 1997 to help insure children whose families earned too much to qualify for Medicaid but not enough to afford insurance on their own. It serves about 6.6 million children annually, but will expire at the end of September if Congress does not reauthorize it.

Senate Finance Committee Chairman Max Baucus (D-Mont.) yesterday called the new requirements a “drastic change” that “jeopardizes coverage for tens of thousands of children in low-income, working families. New policies like this warrant greater transparency before changes are made. I hope the administration will reconsider.”

Rep. Rahm Emanuel (Ill.), chairman of the House Democratic Caucus, said if the president were serious about enrolling the lowest-income children, the administration would allow states to sign up youngsters for SCHIP when they qualify for school-lunch and other federal programs.

“States want to get these kids enrolled, and they will get them enrolled,” said Emanuel, who helped create the program as a staff member in the Clinton administration. “I think states will see the letter for what it is, and that’s a political ploy by the president. This is a political attempt by the administration to try to intimidate states.”

–The New Jersey Star Ledger:

The new rules would require all states to make families wait a year after they lose coverage before they can apply to the government program, according to the letter. The state would also have to prove that 95 percent of the kids from the lowest income levels were enrolled be fore accepting any child from moderate income brackets.

“It’s a real problem. It’s outrageous,” Kohler said. “This is not happening tomorrow, but it’s clear what the intent is — to shut down our program. … There are no regulations to support this, no legislation to support it. This is CMS deciding to do this.”

–Gene Sperling author of “The Pro-Growth Progressive,” President Bill Clinton’s top economic adviser, and now s a senior fellow at the Center for American Progress, has a column on Pittsburgh Live:

The story should have gone like this: “In a rare moment of bipartisan goodwill, the Democrat-controlled Congress delivered the politically ailing President George W. Bush a much needed domestic accomplishment: legislation to provide health coverage for 5 million poor or near-poor children.”

It didn’t quite turn out that way.

In a stunning rebuke to congressional leaders, and to the six (out of 10) Republican Senate Finance Committee members who supported legislation to expand the State Children’s Health Insurance Program, the White House threatened to veto bills that would have covered millions of children.

To see just how poor the administration’s excuses are for saying no, here are a few choice quotes from the Office of Management and Budget’s veto-threat statements.

–The New York Daily News’ Bill Hammond:

President Bush has a message for the millions of parents who can’t afford decent health care for their children: Stop whining and go to the emergency room.

How else to interpret his stubborn opposition to expanding government coverage for kids, the utterly innocent victims of America’s Swiss cheese health system?

First, Bush threatened to veto legislation – passed by bipartisan majorities in both houses of Congress – that would give states money to insure millions more low- and moderate-income children.

Then last week, the Bush administration threw a monkey wrench into Gov. Spitzer’s plan for adding 400,000 more kids to New York’s Child Health Plus program. Draconian rules issued by the feds late Friday would make it all but impossible for Spitzer to achieve his worthy goal of near-universal childhood coverage.

These knee-jerk decisions show that Bush either doesn’t understand the crisis of the uninsured or isn’t serious about addressing it.

“They’re playing politics at the expense of all of these children,” said Jennifer Rojas, deputy director of the Children’s Defense Fund – New York.

         

26 Comments

  1. I find it hard to get worked up about a subsidy program for the middle class. (I know, I know…I’m a miserable heartless bastard.)

    Joe I think it might have been fairer had you quoted this part of the same article:

    If a state wants to set its income limit above 250 percent of the poverty level ($51,625 for a family of four), Mr. Smith said, “the state must establish a minimum of a one-year period of uninsurance for individuals” before they can receive public coverage.

    So, in places like California and New York when you make $51,624 or less you are not subject to these new restrictions. And, yes, there might be some folks living in Manhattan and San Francisco who will really need extra help (and who will get the help if they can show they have been unable to afford insurance for a year), but folks in Fresno or Oswego do not have the housing costs of the major real estate markets and so $52,000+ is probably enough to buy health coverage.

    Is ANY income cut off level acceptable? Or should everyone be able to get governmental assistance regardless of their income?

    And are actual poor people in our society so well taken care of that we can afford to move massive amounts of middle class families off of private insurace and onto public support?

  2. I’m generally wary of any effort to expand government funding in a way that makes it difficult to oppose – opposing this measure paints you as someone who opposes health insurance for sick kids, just as opposing defense spending means you don’t support the troops, and either position is an unfair one for a politician to have to deal with. However, I also don’t think the federal government needs to control what states do, and in this case it seems like micromanagement to limit who a state can cover and how they can do it.

    If California or any other state wants to insure more kids then they should be able to do so. I feel similarly about things like medical marijuana, abortion and gay marriage – if South Dakota wants to ban abortion while California wants to allow gay people to marry while smoking a joint, I don’t see it as the role of the federal government to tell the states they can’t do what they want.

    The tenth amendment gives states the rights not specifically granted to the federal government, and in this case I don’t see that the feds have any right to control who a state spends its money to insure.

  3. You’re right ryan, if you ignore the 5 billion dollars the Feds are paying for the program that was designed to help ensure low income families had coverage for their children.

  4. Ridiculous (though predictable) the way this is being mischaracterized. Along with the quote IW provided, there’s also this:

    Before making such a change, Mr. Smith said, states must demonstrate that they have “enrolled at least 95 percent of children in the state below 200 percent of the federal poverty level” who are eligible for either Medicaid or the child health program.

    Deborah S. Bachrach, a deputy commissioner in the New York State Health Department, said, “No state in the nation has a participation rate of 95 percent.”

    Can anyone argue that we shouldn’t focus on the poorest families first, before expanding coverage to families that are at 400% of the poverty income level? And if some states truly feel that their higher housing costs mean that those families need coverage too…then why doesn’t the STATE pay for the additional families to be covered instead of expecting taxpayers in Mississippi to pay to cover middle class families in Manhatten simply because the real estate market makes it a lot more expensive to live in Manhatten (which incidentally means that NY has a higher tax base from which to draw funds, should they feel the need to expand healthcare coverage within their state).

  5. Iconic midwest and bones: how can you defend the administration in the face of Joe’s vehement attack? don’t you know, being as he’s defined himself as the moderate, that your views paint you as a radical extremist?

    moving along, let’s look at the points joe offers up in his diatribe. (1) the admin is wrong to do anything while congress is on break. (2) congress wants to do something, so the Bush administration is required to go along. (3) hannity and limbaugh’s criticism of this welfare expansion should be discounted because they fly on private airplanes. (4) citing the complaints of supporters of this welfare expansion as evidence of just how wrong it is to object to what they want to do. (5) there is no basis to object to an expansion of a welfare program if one also is in favor of tax cuts. (5) the only people who care about kids are those who want the state to provide health insurance for kids. (6) and my favorite: knowing and referring to someone who could be adversely affected by a change to a government program is the trump card that should silence all critics of that change. sort of a cindy sheehan ‘moral high ground’ play.

    It would be nice if he could offer up some reasons why someone whose family makes 3-4 times the poverty level ($80,000 a year?) has the right to have the federal government to pay for their kids’ health insurance. but I guess it’s easier to just demonize one’s opponents than to offer up arguments in support of one’s preferred policy, right?

  6. It will help the Democrats in ’08 to run against Bush and his backers by portraying them as alligned with Big Tobacco, defense contractors, Big Oil , prescription drug companies and against the most helpless in our society- children of the working poor.

  7. And are actual poor people in our society so well taken care of that we can afford to move massive amounts of middle class families off of private insurace and onto public support

    You have a point Rich–the poorest need to be addressed first. But I also would point out that given the rapid increases in health care costs it can be just as difficult for middle class families to bear the burden as poor families.

    I know that families pay much higher premiums than people who are single or don’t have kids. I also know that many employer-provided health plans aren’t as generous or as cheap as what I’m familiar with through the universities.

  8. Does anyone know why “No state in the nation has a participation rate of 95 percent”?

  9. The problem is that we’re always playing catch-up and doing it in a too little, too late fashion.

    1.We ignore the poor for too long.
    2. Now, some are willing to focus on the poor, but only at the price of ignoring those one step up.

    The reality of a wide range of individuals and families without adequate healtcare coverage is just not sinking in. It’s a wait for this or wait for that game.

    IWhile worrying obsessively about the cost of healthcare coverage, not one of the “principled’ thinkers is calculating the cost of not having adequate coverage. It’s huge. Untreated conditions turn into long term disabilities. What does it cost in terms of what these disabled are NOT contributing to society added to what they cost to just sustain life?

    It’s also a mischaracterization to talk about what is being provided to THEM, whichever one;s favorite suspect and undeserving group is. Whatever is done for THEM results in a gain for all of us, when correctly put in the context of adding to the ranks of healthy, productive fellow citizens and tax payers.

    There is an immediate consequence, but there are also long-term consequences. The latter can be much more serious and costly, if ignored yet again.

  10. Let’s see…10 years ago a decent health insurance plan for a family from BCBS in Missouri (And there was no major difference in pricing from any other insurance company.) cost me $675 a month. The lowest annual increases I received were 11-12%. Yet the assumption on the part of the conservatives here is that a family of four with a gross income of $51,000 has that much money left over to cover health insurance and medical bills after covering other expenses like housing, food, clothing and transportation. Somehow I just don’t buy it.

  11. I wrote this over at my site, but I will highlight it here as well:

    Just for giggles I looked at the health insurance plans offered by Blue Cross in California. For a family of four living in the Haight there were ten plans offered with monthly premiums of between $209 to $384. Of course, health insurance needs vary from family to family, but it doesn’t seem impossible to get affordable coverage in principle, especially for a family bringing home between $4000 and $5000 a month income. I’m not saying some folks might not need help with prescription drug costs or catastrophic care, but dealing with such costs is not the point of the SCHIP program.

    Jim, it looks like you were being hosed. (Of course your family might have other costs because fo chronic conditions I don’t know about, OR you payed extra for a plan with less out of pockets exspense…I don’t know.)

  12. The plan did help minimize out of pocket expenses. The cost of the BCBS plans you mention means nothing without an idea of what they cover. If they still leave large out of pocket expenses and have huge deductibles it means you will pay thousands of dollars a year just for the right to still be bankrupted should any serious illness hit your family. Of course this is not an uncommon occurrence for people with insurance.

  13. True Jim, but there are other program out there to help with other sorts of health care related expenses, and yes some of the BC plans had other expenses involved. (There was no way I was going to be able to summarize all the the health care coverge offered by the myriad of plans.) The point is there IS coverage available that people can afford. (And I only looked at ONE provider. I don’t know what else is out there.)

    Also, this program is such a blunt instrument that it simply casts too wide a net. Sure a family living in the Haight in San Francisco lives in a pretty expensive place…but what about people living in far less expensive palces in California? Or New Jesey? Or New York? What is the rationale for subsidizing THEIR insurance?

  14. Sure, there are ‘affordable’ plans out there. The meaningful thing about them is, however, what they DON’T cover. It’s not necessary to have a catastrophic disease or estraordinary requitements for medicine in order to see out of pocket expenses outstrip by far the benefits of the plan. There are also the pre-condition loopholes and other porhibitions to overcome..

    It takes an understanding of overall healthcare costs (insurance + out of pocket payments) to grasp what is at stake for many families, and I’m not talking only about families with extraordianry health challenges. An ordinary middle class family can easily find itself up against the ropes, and the ‘affordable’ plans don’t answer their needs.

  15. Jim,

    If you want to check it out yourself go to the Blue Cross page and get a quote yourself. (I used the 94117 Zip Code for the Haight, had a married couple 38 and 37 years old with two kids aged 6 and 4.)

    I just talked about the options under $400. There were a bunch of plans in the $400 to $500 range as well.

  16. It takes an understanding of overall healthcare costs (insurance + out of pocket payments) to grasp what is at stake for many families, and I’m not talking only about families with extraordianry health challenges. An ordinary middle class family can easily find itself up against the ropes, and the ‘affordable’ plans don’t answer their needs.

    How?

    What you are saying is that a family of four, with no unusual health issues, making say $60,000 a year, will be in dire financial straits because of everyday normal health care concerns?

    How?

  17. “what about people living in far less expensive palces in California? Or New Jesey? Or New York? What is the rationale for subsidizing THEIR insurance?”

    And why are they living in less expensive regions?
    I doubt there are too many people with good incomes who choose to invest in a home with a low equity potential. Working plus living in a cheap area already points to families in economic difficulties.
    BTW, I’d be interested to know where the areas of NY with cheap housing are. Even in the worst areas, rents are exhorbitant and taxes for homeowners sky-high. In fact, he housing crisis should be right up there with health care as a growing problem for the not extremely wealthy.

  18. Extra subsidies to those living in high-cost areas will only exacerbate the housing crisis (which exists primarily in those areas). A flat subsidy (via SCHIP) regardless of market makes sense because health care costs (mostly and AFAIK) don’t vary by region anywhere near as much as housing costs. People get the benefits of dispersing to lower-cost, more stable markets, in a way that could offset the lower incomes in those areas. This encourages housing stability.

    If you can’t afford NYC or the suburbs, the SCHIP provides a cushion for you to take a pay cut and live somewhere more within your means. Writ large, lower-middle class communities get added investment and a much-needed shot in the arm – after all, that’s presumably where many of the subprime foreclosures are takling place.

  19. IM-
    It depends on what one considers ordinary.

    I would say that the unexpected is part of ordinary life: a broken leg, a trip to the emergency room for an asthma attack, etc. The reason for buying any insurance is to have a cushion for those times when the unexpected happens. If ‘ordinary’ means constantly healthy and accident immune, then there is no need for insurance of any kind. All health care needs would be covered by a yearly physical in the G.P.’s office, something many of those we are discussing could afford even easier than the ‘affordable’ health insurance plans.

    But that’s not how life works, and those with families have to plan for the unexpected,. If they’re lucky, they won’t face the catastrophic level, but many have to face even that.

    It used to be the basic principle of insurance that risk is spread out among the population of consumers. If one policy holder incurred greater costs, those would be balanced out by the premiums collected from those who incur less than their share.
    With ‘affordable’ plans, the tendency is to expect each policy holder to underwrite his own costs in real time. It’s done with deductibles and excludables and pre-condition prohibitions. That’s the shift that is undermining the whole system.

  20. And why are they living in less expensive regions?

    You have any idea how that sounds?

    Maybe folks LIKE Oswego or Albany, maybe they were born and raised in Fish Camp, California, or Fresno.

    I would say that the unexpected is part of ordinary life: a broken leg, a trip to the emergency room for an asthma attack, etc. The reason for buying any insurance is to have a cushion for those times when the unexpected happens.

    So how would a family with $1000 deductible on their insurance making $60,000 a year be undone by someone breaking their leg? It might very well hurt the budget for awhile, but isn;t that life as well?

  21. Iconic:

    Especially in light of your name you sure seem to have a coastal bias. As far as affordable places, why not, oh, virtually anywhere in the midwest? Out here, a true “middle class” family could fall under SCHIP, especially at 250% of poverty. I think that is a reasonable increase. 350% plus, not so much.

  22. And why are they living in less expensive regions?

    If you are going to think in these terms at all (as though everyone’s place of residence can really be determined strictly on issues of cost), then a more apt question would be the reverse. To channel the late Sam Kinison, for people who feel that their region’s cost of housing makes it impossible to meet the costs of health coverage, WHY DON’T THEY GO WHERE THE AFFORDABLE HOUSES ARE?!?!?!?!?

    [Note: I am well aware that this is a silly question, but much less silly than asking why people live in LESS expensive areas IMO]

    Jim S: Yet the assumption on the part of the conservatives here is that a family of four with a gross income of $51,000 has that much money left over to cover health insurance and medical bills after covering other expenses like housing, food, clothing and transportation. Somehow I just don’t buy it.

    I made no such assumption, Jim. But if the purpose of SCHIP is to provide coverage for low income kids, then it seems to me that the program’s funds should be used to cover low income kids rather than letting middle class families take advantage of it while many poor kids and families are left out.

    There is a need to address middle class families who still can’t afford healthcare coverage, but that needs to be addressed in a much different way (like working toward lowering overall costs of healthcare-which requires comprehensive and multifactorial changes such as increasing supply of physicians(and other providers) and healthcare technology, tort reform to reduce malpractice costs, and allowing the poor access to preventative healthcare instead of just the emergency room- since the costs of that gets passed along to every healthcare consumer), and making it possible for people to shop indepdently for insurance instead of giving a competitive edge to employers.

    Trying to solve the affordability problem by bringing more and more people under the umbrella of coverage by the federal government is a disaster in the making. Medicare itself is a ticking time bomb; now we’re going to make health care into a nuclear bomb because the costs will become so astronomical when we increasingly bring the middle class into the programs.

  23. “much less silly than asking why people live in LESS expensive areas IMO]”

    I guess irony is unfamilirar to some.

    As for the rest of the wait for this, wait for that, I would point out that real people are tired of waiting for all the idealogical ducks to line up in a row. They have to deal with their family’s health care needs NOW.

    Should the country come to its senses and adopt a healthcare system availabe to everyone, the need to expand existing and narrowly defined programs would disappearwithout fanfare. In the meantime, the need is there, but the available avenues for addressing them are exceedingly narrow. Provide a wider avenue first, and then we can talk about which lane everyone should take.

    BTW. ‘reforming’ the bankrupcy laws did a lot to narrow the options for hard pressed families faced with insurmountable medical bills. There are political ideals, and then there are families stomped on by those ideals

  24. Especially in light of your name you sure seem to have a coastal bias.

    I’m not exactly sure what you mean by this. The NYT article singled out California, New York, and New Jersey because they wanted to raise the threshold way about 250%. They were singled out because of the high cost of living (relatively speaking) of those places. MY POINT is that even in higer cost of living states like California and New York, there are cheaper communities for whom raising the threshold above 250% seems pointless, or a waste of resources. Obviously, cheap places like Missouri do not need it raised way above 250%. If you make $70,000 a year in St. Louis you are doing WAY alright.

  25. Once again tort reform is cited as being significant to reducing health care costs. Here is a CBO report from 2004 on the issue. Does anyone really thing that anything has changed significantly in 3 years?

    Allow the poor access to preventative care? I don’t see any market based solution that’s going to allow that. And since you bring up the bromide of having individuals shop for insurance (and wade through all that lovely small type that explains the loopholes the insurance company counts on) I assume your primary interest is in market based solutions. Pardon if it’s an unwarranted assumption.

  26. Yes, it is unwarranted to say that I believe the whole problem can be solved through market based solutions. You are correct that I think the market can be made to function better on that one aspect, allowing greater consumer choice in insurance products (I guess I have more faith in people’s ability to read and select the plan that best suits them). The part about allowing access to preventative care for the poor is obviously not a market based solution. My concept would be to overhaul the entire health care delivery system, increasing the delivery of preventative healthcare (for everyone) by physicians assistants- and providing access to these providers for the poor.

    And on tort reform, I’m certainly not suggesting that it is the complete solution- but taking several steps to reduce overal medical costs and improve efficiency will have an additive effect. If you need to cut household expenses, buying cheaper brands at the grocery store isn’t going to balance your budget but it can be part of an overall strategy to make ends meet.

    And tort/malpractice reforms also need to be examined from the standpoint of physician supply; if the current rate increases continue, it’s likely that certain high risk specialties will experience declines so that there will be shortages in some areas. As we are trying to expand healthcare coverage, a decrease in supply as demand increases could be disastrous, leading either to exhorbitant costs or long waiting lists, or both.

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