LC 2.5 The Lincoln Single Payer Healthcare Act (General debate)

[Fmr. Representative Encke]

Does anyone else have something to add to the bill. I would personally like to debate whether or not we should include the funding for the bill in the bill itself (which would require some sort of cost estimate) or later in the budget process (which might mean an unexpectedly large deficit later on)

I'll point out that the balanced budget provision in the old Lincoln constitution was carried over with the Philly Plan, so running a deficit is actually unconstitutional. It would be prudent to figure out the budgetary situation before passing this bill, considering this may very well double spending (using RL state single-payer proposals and cost analyses as a guide). I will be working on a cost analysis soon, but it may take a while.

[Fmr. Representative Encke]

Are 2016's budget numbers artificially low or about right? Because 500 million in expenditures seems somewhat low for the regional government. Then again I guess it's a regional government we are talking about.

This depends entirely on what is actually being funded. Lincoln seems to have taken a page out of the South's book by absorbing all state-only spending (presumably) and using the same broad categories (taken from the USGS site), excluding local spending. However, considering the lack of specificity, I wouldn't be surprised if some of the 2016 numbers were fudged. So basically we don't actually know what Lincoln is and isn't funding within each of these categories, because that conversation has never taken place.

If we assume that the 2016 spending numbers were derived by summing the USGS state-only column, then 550 billion in expenditures is roughly the expected value (although there may be some differences in specific categories). However, if one assumes that Lincoln is at least partially funding things like K-12 education, water supply, sewerage, waste management, etc., on top of things in the state-only column, then the 550 billion figure is too low.

If you take a look at the data from Fremont, which I outlined here, you'll see a basic breakdown of RL funding for FY2019. Lincoln's numbers will obviously be different (and I haven't gotten around to doing them yet), but the basic proportions will most likely be similar. One of the things that Lincoln should decide this year is which specific things they are and aren't funding.

[Fmr. Representative Encke]

818 billion, folks.

Lincoln Single Payer Cost Analysis

To start with, I re-checked the US Government Spending site, which is the source for the RL state spending baselines, and found that the 2019 state-level healthcare estimates had changed from 269 billion to 252.364 billion. So you can probably go and change that in the budget. The site changes its estimates rather frequently so sometimes numbers that are compiled months earlier will no longer be accurate when the budget is finalized.

Anyway, the healthcare segment of the expenditure pages on the site is broken down into four categories: Health, Hospitals, Current Operations - Environmental Health, and Vendor Payments for Medical Care. The sum of all of the spending in each of Lincoln's constituent states is shown below. Since the Lincoln budget is only absorbing the state-level expenditures, only the values in the first column are relevant.



The revenue 'codes' are described in detail on this site. Here are the relevant items (I'm excluding Code 27 because spending in that category is nearly negligible):

CODE 32: HEALTH

DEFINITION:    Provision of services for the conservation and improvement of public health, other than hospital care, and financial support of other governments' health programs.

EXAMPLES:   Public health administration, laboratories, public education, vital statistics, research, and other general health activities; categorical health programs (e.g., control of cancer, TB, socially transmitted diseases, mental illness, etc. and maternal and child health care); health-related inspection and regulation (e.g., inspection of restaurants, water supplies, food handlers, nursing homes, etc.); community and visiting nurses; immunization programs; out-patient health clinics; regulation of air and water quality, sanitary engineering, and other environmental health activities; rabies and animal control; abatement of mosquitoes, rodents, and other vermin; ambulance and emergency medical services ONLY IF handled separately from fire department; alcohol and drug abuse prevention and rehabilitation; school health services provided by a health agency; activities funded by Federal W.I.C. funds--Women, Infants, and Children. For Federal Government also includes Food and Drug Administration and Environmental Protection Agency (except sewerage construction grants).

EXCLUSIONS:   Vendor payments for medical appliances, supplies, or services under public assistance programs (use code E74); examination and licensing of health-related professions--e.g., doctors, nurses, and barbers (report at Protective Inspection and Regulation, NEC, code 66); activities related to agricultural standards or protection of agricultural products from disease (report at Other Agriculture, code 54); operation or construction of nursing homes (report at Public Welfare, codes 77/79); vocational rehabilitation (report at Education, codes 18/21); coroners and crime labs (report at Police Protection, code 62). For Federal Government exclude veterans' medical care (report at Veterans' Health, code 28).


CODE 36: HOSPITALS

DEFINITION:    Hospital facilities providing in-patient medical care and institutions primarily for care and treatment of handicapped (rather than education) which are directly administered by a government, including those operated by public universities. Also covers direct payments for acquisition or construction of hospitals whether or not the government will operate the completed facility.

EXAMPLES:   Government-operated general hospitals; institutions for the custody, treatment, or general care of the mentally insane or defective, feeble-minded, mentally retarded, or emotionally disturbed; TB sanatoria, maternity and children hospitals, orthopedic hospitals, and hospitals for chronic diseases; institutions for care and treatment of blind, deaf, developmentally disabled, or other special classes of handicap; hospitals associated with university medical schools (including paid student help).

EXCLUSIONS:   Nursing homes (or other welfare institutions) not directly associated with a public hospital (report at Public Welfare, codes 77/79); state schools for blind, deaf, or other handicapped primarily for education and training (report at Other Education, code 21); hospitalization of persons in other public or private hospitals (report at Other Hospitals, codes 38/39); payments to private vendors for medical care under welfare programs (use code E74); support of other public or private hospitals (use code 38); infirmaries serving particular institutions, like college infirmaries and prison hospitals (report at function involved); hospitals for criminally insane operated by corrections agency (report at Correctional Institutions, code 04); payments to or employment of private corporations which lease and operate government-owned hospitals (for payments, use code 38); instructional staff of medical school hospitals (report at Other Higher Education, code 18); veterans hospitals operated by U.S. Veterans Administration (report at Own Hospitals-Veterans, code 37).


CODE 74: VENDOR PAYMENTS FOR MEDICAL CARE

DEFINITION:    Payments under public welfare programs made directly to private vendors (i.e., individuals or nongovernmental organizations furnishing goods and services) for medical assistance and hospital or health care, including Medicaid (Title XIX), on behalf of low-income or other medically-needy persons unable to purchase such care.

EXAMPLES:   Payments to private vendors for: physician and other professional medical services, private hospital care, drugs and medicines, dental services, long-term health care (including hospices), home health care, dialysis treatment, medical appliances (e.g., prostheses), ambulatory care, laboratory services, eyeglasses and hearing aids, and so forth; premiums paid to insurers for future medical costs of needy persons. Includes all direct payments to private hospitals or health care providers under Medicaid, general relief, public assistance, and any other Federal or state welfare program.

EXCLUSIONS:   Direct payments to benefited persons themselves (report at Other Cash Assistance Payments, code E68); administrative activities, setting of provider fees and rates, establishing standards, etc. (report at Other Public Welfare, code 79); intergovernmental payments to other public hospitals for medical assistance under public welfare programs (report payments from Medicaid funds at Federal Categorical Assistance Programs, code 67, and payments from all other funds at code 79); medical commodities, services, or other assistance provided through government's own hospitals or health agencies (report at Health, codes 28 / 32, or Own Hospitals, codes 36 / 37); state payments to finance locally-administered medical assistance (Medicaid) programs (report at code 67 [sic]); premiums for health insurance coverage for government's employees (report at function of paying agency or, if a government-wide payment, at Other and Unallocable, code 89).

Therefore, a transition to a single-payer system would *only* absorb the expenditures for Code 74, while services for special groups, defined in the R&RPH as 'active duty military, veteran healthcare and senior healthcare, and the other special groups as detailed in Part III' would still covered by AtlasCare regardless of an opt-out for instituting single-payer. Therefore, I am not factoring those costs into the bill.

Long story short, here's my estimate (818 billion dollars). Relevant information is recorded in the footnotes.: