August 1, 2012
Host: Ted Simons
47 Years of Medicare & Medicaid
- 47 years ago the nation’s Medicaid and Medicare programs were born. We’ll take a look at the history and evolution of those programs and the challenges they’re facing today with a special emphasis on Arizona’s Medicaid program, the Arizona Health Care Cost Containment System (AHCCCS), which is now in its 30th year. Guests include AHCCCS Director Tom Betlach and AARP Arizona State President Dr. Leonard Kirschner who is a former AHCCCS Director (1987-1993).
- Tom Betlach - Director, AHCCCS
- Dr. Leonard Kirschner - State President, AARP Arizona
| Keywords: medicare
Ted Simons: 47 years ago president Lyndon Johnson signed Medicare and Medicaid into law. Tonight we take a look at how those programs have changed through the years and some of the challenges they face today. We should also note 2012 is the 30th anniversary of Arizona's Medicaid program, the Arizona health care cost containment system or AHCCCS. Here to talk about these programs is Arizona's AHCCCS director Tom Betlach and AARP Arizona state president Dr. Leonard Kirschner, who served as the state's director from 1987 to 1993. We'll start with AHCCCS and Medicaid. Give us a definition.
Tom Betlach: AHCCCS, health care cost containment system is the state's Medicaid system created in 1982, the last state into the Medicaid program. Medicaid is a program for low income individuals, so you have to meet a certain income threshold then you're eligible to receive services through that Medicaid program.
Ted Simons: Federal program administered by the state.
Tom Betlach: exactly. It's a partnership program created that way 47 years ago and so the state chips in part of the cost, federal government chips in part of the cost. Then the state is allowed to set some policy direction and the 8 federal government provides some of the overarching policies.
Ted Simons: Give me a definition for Medicare.
Dr. Leonard Kirschner: It was signed at the same moment by Lyndon Johnson at the Truman library in independence, Missouri. It was an afterthought. Medicaid was the afterthought. Medicare was a compromise crafted after decades of arguments, part A, with the hospitals, part B, with the doctors, signed into law at the Truman library. I have the first application here for Medicare is signed by Harry Truman and it's endorsed and witnessed by Lyndon Johnson.
Ted Simons: This is a federal health insurance program for folks 65 and over and certain medical conditions as well, correct?
Dr. Leonard Kirschner: Correct. It started by being an old blue cross blue shield model. Part A, for the hospitals, part B, for the doctors. Different definitions. Since then we have added part C, and part D, Medicaid covers some of the cost and it's a multitude of individuals. We have 47 million Americans, we have over 900,000 in Arizona on Medicare.
Ted Simons: I want to get the history to Medicare in a sect. As far as Medicaid, you mentioned 1982. If we go from '65 to '82 we're looking at 17 years of what?
Tom Betlach: 17 years in which the state made the decision that it was not going to participate in the Medicaid program. There came a point in time in which the counties at that point in time are responsible for providing indigent care. They came to the point where though couldn't afford it any more. They went to the legislature. The legislature said, well, we have a lot of concerns about an entitlement program but if the federal government will listen in terms of wanting creating something different, it's something we want to pursue. That's when AHCCCS was born. It was created in such a manner it mandated managed care, which was a completely different model than any other state.
Ted Simons: Was Arizona looking at other states or was Arizona looking to be different?
Tom Betlach: Arizona was looking to be different. It became a leader in terms of that managed care model. Since then it's grown to about 70% of Medicaid recipients nationally are now in some form of managed care. It really was a leader at that point in time. It's been a model that other states have pursued since then.
Ted Simons: As far as Medicare is concerned you've talked and written about this in the early days. An afterthought in a sense but you also --
Dr. Leonard Kirschner: That's right. Medicaid was the afterthought.
Ted Simons: But as far as Medicare was concerned it was considered a tribute to JFK.
Dr. Leonard Kirschner: Correct. It was 1965. Arizona had a part of that because Lyndon Johnson won a huge electoral victory over Barry Goldwater, our native son. When he came into office, he pushed very rapidly, which is something that other presidents have not done, FDR did it, moved rapidly to have legislation. There was lots of bickering, lots of compromise, there was lots of battles. When it passed if you look at the vote in the Congress and the Senate, you read some of the quotes from Barry Goldwater, Ronald Reagan, who opposed Medicare, very similar to today. Now, it was the summer of 1965 to be frank I was on my way to Vietnam. I got to Danang about a month later. I was more worried about SAM’s, MIG’s and incoming than health policy. Two years later I was at Harvard getting my master's in public health. Our professor said, don't worry about these programs. They are temporary programs. Here we're 47 years later, they cover 100 million Americans and they’re going to spend $1 trillion of taxpayer money this year.
Ted Simons: How has—I want to get to how Medicare has changed over the years—but how has AHCCCS evolved? We have had some changes in the past year or some of the give us a cliff notes history here.
Dr. Leonard Kirschner: Some significant milestones were 1989 we had long term care program. Those individuals that were living in institutions or at risk of living in an institution in 2000 we had a voter initiative, proposition 204, when the voters said we want to expand AHCCCS up to 100% of federal -- about $22,000 for a family of four through that initiative Arizona became a state, one of six, that expanded coverage to that level. The next major milestone was happened recently, that's with the affordable care act, then the Supreme Court decision that said no, Congress can't mandate and stipulate that states have to expand further their Medicaid program, it's really an option for the state to make that decision. So I imagine we'll be talking about that more over the next many months in Arizona. Those are the major milestones in the AHCCCS program.
Ted Simons: Major milestones in Medicare.
Dr. Leonard Kirschner: Medicare was a program that was temporary in place. I was at a meeting in New York with Joe Califano a number of years ago. He was the points person. He said he knew these programs were kind of strange but it doesn't matter. They weren't going to be around very long. They could be subsumed in a national health plan in the second Lyndon Johnson term, the first Hubert Humphrey term. That didn't happen. It's evolved over time but basically Medicare hasn't changed as much as Medicaid. Probably the biggest change was the prescription drug plan. That was always intended to be there. I have a document that said in 1967 eyes only, we need a prescription drug plan. Well, 40 years later we have one. Managed care has been added to Medicare. So we have Medicare advantage plans. Which are modeling what we did in Medicaid. The states have really been the laboratories for change, innovation. The federal government has really been laggards in doing that. That you have to give credit to Arizona and the other states like Minnesota and Oregon that really cut through some of the nonsense.
Ted Simons: With that in mind and the affordable care act, assuming it goes forward as planned, does AHCCCS continue to exist? How does that work?
Tom Betlach: AHCCCS continues to exist. The policy question for the governor and the legislature is at what level do we cover. So there's really two points to that policy decision. The first is the voters have already spoke through proposition 204, so we are currently have a freeze in that population because we don't have available resources but the state's great recession and all the challenges we faced. The second question becomes, okay, looking at proposition 204, is the state interested in going above and beyond that? That's the second policy question. That really needs to be addressed over the course of the next several months leading to the legislative session next spring.
Dr. Leonard Kirschner: There's one other policy question. That's kids care. We're the only state that has put a cap on kids care. Last I heard about 100,000 kids on a waiting list.
Tom Betlach: That's not the case any more. There's a lot of details around. That we have coverage for about 13,000 kids that have been added.
Dr. Leonard Kirschner: That's still been a problem in our Medicaid program.
Ted Simons: As far as the affordable care act and its impact on Medicare, what are you seeing?
Dr. Leonard Kirschner: It's improved a lot of things in the Medicare program in ways of preventive health care, women's health care. It's added some other preventive care, some of the good things you would want in a program. It isn't a huge change in Medicare per se. The Medicaid expansions and the changes in the insurance market for those who have employer based insurance are far more marked than for the Medicare program per se.
Ted Simons: I want to give you a last word. You were around for all this business. The impact on just the healthcare for the average American. Medicare and Medicaid. Got about a minute.
Dr. Leonard Kirschner: I think there's going to be tremendous improvement especially if we take the opportunity to get those federal dollars to expand health care. If you cover people under Medicaid and a study of the New England journal came out, you have much better results, death rates go down. The impact on people is impressive and so we ought to think about universal health care in this state. We're nowhere near. That I think these changes in the affordable care act can move in that direction.
Ted Simons: Good to have you here. Great discussion. Thanks for being with us.
Tom Betlach: Thank you.
Arizona’s Latino Vote
- The ASU Morrison Institute for Public Policy has released a new report, “Arizona’s Emerging Latino Vote”, which focuses on the potential for Arizona’s young and growing Latino population to change the State’s political landscape over the next few decades. Learn more about the report from co-authors Bill Hart, a Morrison Institute senior policy analyst, and Dr. Eric Hedberg, a faculty associate in the ASU College of Public Programs.
- Bill Hart - Senior Policy Analyst, Morrison Institute
- Dr. Eric Hedberg - Faculty Associate, ASU College of Public Programs
| Keywords: ASU
Ted Simons: Arizona Latino voters could change the state's political landscape in coming decades according to a report released today by ASU's Morrison institute for public policy. It's titled Arizona's emerging Latino vote. Here are co-authors Bill Hart, senior policy analyst for the Morrison institute, and Eric Hedberg from the college of public programs. Thanks for joining us. Dramatic shift in Arizona's political landscape what. Does that mean?
Bill Hart: That means, the main driver of this report, and what we see as shape of politics in Arizona in the next few decades, is a large growth in the Latino population. A really fundamental demographic shift that's going on in Arizona as in some other states in which we have a large population of young Latinos who are gradually aging into the voter level age and we have a small and shrinking number of non-Hispanic white population.
Ted Simons: And as far as a time frame for this particular shift, is it slow and gradual? When do we see tangible results on what the study suggests?
Eric Hedberg: It is going to be slow and gradual. I would expect the balance of power to be reached by about 2030. I think as we get to 2030, we're going to see both parties start to realize what's happening and rearrange their positions.
Ted Simons: Does that change the goal posts as far as future projections are concerned? Politics so dynamic, difficult to project what's going to happen a couple decades down the line.
Eric Hedberg: politics is very dynamic but one thing as a sociology I'm trained to understand and realize is that world views and political opinions are heavily influenced by one's childhood. Since the main driver of this sea change are the children today who are citizens who are going to be voters, I think we can look at what's happening today and look towards the future.
Ted Simons: That's interesting you mention childhood and young people. You refer to this just a couple seconds ago, this Latino electorate while growing will also be in many respects growing older. That's a factor, isn't it?
Bill Hart: Right. That will probably presumably affect their political point of view. The big point, however, is again children and adolescents are such a large cohort of the population that as they grow, and we're assuming, now, that they will keep to traditional preferences. Latinos in America locally and nationally have typically voted democratic. Increasingly in recent years they seem to also be identifying as independents, so it's those two groups, particularly independents, as increasing in the future.
Ted Simons: How do you explain so far, we have heard a lot about the Latino electorate and we’ve also heard about how it seems under-represented come voting day. Come election day. Why does, again, the fact that the group as a whole gets older more likely to vote? Is that why you think the numbers would be --
Bill Hart: That's part of it. The main thing is the sheer size of the Latino population, however, I think you're right in that typically in general older people vote more -- register and vote more often than younger people. People of slightly higher incomes register and vote more than lower income people.
Ted Simons: As far as the data used, what was used and how were the projections formulated?
Eric Hedberg: We used the projection from Geolitics, a marketing and demographic company on the east coast. They use the standard demographic methodologies to project out based on past migration patterns and so forth. We combined that with census data, both from the American community survey to establish citizenship rates for each specific age group,and the 2010 current population survey voter and registration supplement.
Ted Simons: So taking those particular sets of metrics and such, how do you extrapolate, if I may be so bold, that information to I think a sentence in your report is dominating the political scene in a couple of decades or so. How do you get to that?
Eric Hedberg: When we say dominate the political scene, you're not talking in terms of a majority. We're talking about the key players that can shift the balance. Where the focus is going to be. Because they are going to come, because so many will be independent I think they will dominate in that they will be the Keystone.
Ted Simons: Talk about that independent vote again. We understand mostly Democrat right now. We don't know what's going to happen. we also see this independent voting block just exponentially increasing over the years. How does that play? Talk about that dynamic.
Bill Hart: It's increasing rapidly if you look at the registration levels officially over the last few years. It's growing, about the same as the Republicans or Democrats, which is a new phenomenon. How that will play out is very hard to say. It means that certainly Arizona will increasingly be in-play it seems. Not necessarily a red or blue state but a state that could go either way. I think that particularly could happen if the ballot proposition for this November for what they call the top two primary, if that is successful and is passed, that could drive up the independent numbers even more.
Ted Simons: You were talking about a couple of decades. Is this the kind of thing we could see something tangible come this November?
Eric Hedberg: This report is not going to go into specific immediate predictions. We're definitely talking long term. Actually I feel more comfortable talking about the long term than I do about the short term. But the important thing from this report is that this is going to be a source of political slack that different parties can use and take advantage of.
Ted Simons: As far as impact on public policies down the line? Pretty strong I would imagine.
Bill Hart: I think very strong. Again, the underlying point is this is based oon a demographic process that's not something we made up. It's not our opinion. It's not really contestable. It's going to happen. What the ramifications are for any party we're not sure, but it certainly needs to be recognized and responded to by everyone involved.
Ted Simons: And if anyone wants to read the report, find it on the Morrison institute website?
Bill Hart: Right.
Ted Simons: The address --
Bill Hart: Morrisoninstitute.ASU.EDU.
Ted Simons: Thank you for joining us.
Bill Hart: Thank you.
New Arizona Booster Seat Law
- Starting August 2, Arizona law requires children riding in a motor vehicle to be seated in a child restraint system, such as a booster seat, until their 8th birthday or until they’re at least 4 feet 9 inches tall. AAA Arizona spokesperson Linda Gorman discusses the new law.
- Linda Gorman - Spokesperson, AAA Arizona
| Keywords: AAA
Ted Simons: Arizona new booster seat law takes effect tomorrow. Here to tell us what the law requires is Linda Gorman of Triple-A Arizona. Good to see you again.
Linda Gorman: thanks for having me.
Ted Simons: What's going on here?
Linda Gorman: Well, up until tomorrow, actually, the law only protected kids up until the age of five, so of the there was a major loophole in our existing law. The existing law required kids up to the age of five to be in a proper child safety seat. At five they could then transition to an adult seatbelt which we know doesn't properly protect them.
Ted Simons: What is a proper child seat?
Ted Simons: It depends upon the child there are a lot of different seats you can buy. There's an infant seat where it's very, very small kids are in that attaches to a base. There's can be a convertible seat that you can use as the child grows that eventually can turn into a booster seat. There's also a booster seat that you can use for older children.
Ted Simons: As far as booster seats are concerned, how do you install them safely? What are some of the common mistakes?
Linda Gorman: A great thing about a traditional booster seat, there is no installation, you can take it from car to car, to the grandparents' house. The whole purpose is just to sit on the seat, give kids that needed boost so the seatbelt fits them properly in the event of a crash. We do see people who have those traditional types of seats that are actually installed up to 90% of those seats are installed incorrectly.
Ted Simons: How?
Linda Gorman: They are not tight enough. Seats shouldn't move at all back and forth. Many times they are not tight enough, the seat isn't properly fitted for their car. A lot of things that we see. The best thing is to make sure you get it checked by a technician.
Ted Simons: This little girl has the strap going across her neck. That doesn't look -- is that something else to be concerned about?
Linda Gorman: That is. Up until even today that would be okay by the law but you can see the seatbelt comes across her neck. It's not positioned across her chest correctly. It's positioned on her abdomen. If she were to be in a crash, she could be ejected. She could have spinal injuries, internal injuries. Some of the medical professionals we have talked to have seen things like paralysis in kids that are in these adult seat belts.
Ted Simons: This law has been around for a while. Attempts to get this law through. Around for a while. Failed in previous years. Why did it pass now?
Linda Gorman: I think a lot of it has to do with education. We joined 47 other states that are going to be providing proper protection to children. So Triple-A has worked as you said for many years, about five, very tirelessly to pass this. It's about education. Not only legislators but about the public and parents to let them know the state is not providing the right guidance for them. The medical community was extremely important this year. We had great coalition partners in terms of hospitals, trauma centers, doctors, firefighters to help weigh in and say, yes, this law is needed and it will save lives.
Ted Simons: Some of the criticisms in the past included the idea for low income family and care-givers this is a hefty cost. How much does a booster seat cost?
Linda Gorman: You can buy one as simple as $15. Others have all the bells and whistles and cup holders but they cost as little as $15. Get news is there are programs available, low cost and no cost programs, for families who are struggling and who need that assistance.
Ted Simons: I know some of the past criticism was that it's legislative parenting, too much government introduction. How did you get that mind shift?
Linda Gorman: Well, just by educate willing people that we already have an existing law. This isn't a new law on the books. We already have a law that protects kids up to the age of five, however it's not doing its job preventing crashes and injuries in older children. We have a responsibility to give parents the most updated advice, updated guidance and protect those kids until they can transition into that seatbelt.
Ted Simons: What will be the penalty for failure to comply?
Linda Gorman: It's about a $50 fine. The good news is that can be waiveed if you attend a child safety seat class or you show proof when you go to the judge that you have purchased that seat.
Ted Simons: This is correct my if I'm wrong considered a primary offense meaning that police, law enforcement wouldn't have to stop you for something else. If they stop you for this, good enough.
Linda Gorman: Yes, extends the entire child passenger law as primary. So the existing one is primary. Now it just extends that up to the age of eight or four feet nine inches.
Ted Simons: Bottom line, will it make that much of a difference considering some folks still seem to think adult seat belts are good enough?
Linda Gorman: Unfortunately they are not. If you look at the data, all of the deaths in Arizona in 2010 between that age group, that vulnerable age group from five to eight, all of them were improperly restrained. We do know that the use of a proper child safety seat prevents fatalities by as much as 71%. So it saves lives, it saves lives in 47 other states. We're looking forward to the same benefits.
Ted Simons: All right, very good to have you here.