What does SNF mean? It means skilled nursing facilities and in in the state of Illinois, skilled nursing facilities are nothing more than nursing homes. You see, I've got a patient that needs help with her activities of daily living. She simply cannot provide for herself in a manner consistent with independent living. She might have some benefit from physical and occupational therapy. Maybe. In our attempts to get her transferred to her home state of Illinois we learned that Illinois Medicaid patients can no longer receive paid physical and occupational therapy at
skilled nursing facilities nursing homes. Why you ask? Because the state of Illinois cannot afford to pay for it any more. If you think hospitals can survive on Medicaid, you are mistaken. The state of Illinois cannot even survive on Medicaid.
They just increased their state income tax by 66% to shrink a 13 billion dollar gap in
state revenue short falls too much spending. I suppose one way to cut costs is to slice physical and occupational therapy out of the budgets for poor black and Hispanic Medicaid recipients in their state. Nurses can't do PT and OT well, no matter how you dress it up. Why would they? They've never trained to be therapists. If you think doctors and hospitals are going to stop providing certain services for Medicaid patients, you would be correct. In fact, many doctors are not accepting Medicaid in my hometown. Good for them. The only way to force change is to make it happen.
It's only a matter of time before the Medicaid contagion spreads in full force to Medicare. I've heard some doctors explain that 85% of their business is Medicare while only 15% of their revenue comes from the Medicare National Bank. They've talked about exiting Medicare, working 85% less, and taking a 15% paycut, which can more than be made up from building up cash or concierge medicine models of care. There are always people willing to pay for something extra. The losers will be the old and the poor on the take for government funded health care.
Medicaid is bankrupt. ObamaCare forces states to implement massive increases in funding for a program that already pays less than the cost to provide care. The economics just aren't there for a rational expansion. Illinois is one of the states most likely to default on their bond obligations. If anyone has been paying attention as of late, you would know the municipal bond market is in shambles. The Illinois budget shortfall is 40% of its its 2011 expenditures resulting in the massive state tax increases. Just about every state in this Union is experiencing the same. Business has begun a mass migration out of Illinois as a result of their tax and spend disgust.
I pitty the poor people of Illinois. But this is ultimately the road that FREE=MORE will take. Bit by bit, services will be cut, doctors will quit and hospitals will close for good. In fact, even insurance companies will quit because they know the economics aren't there to survive. And I wouldn't blame any of them one bit. Obamacare will only accelerate this death spiral we find ourselves in. But don't you worry. If you're a 99 years old in need of a medically necessary defibrillator, you can still get one.