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The Spokesman-Review Newspaper The Spokesman-Review

Spokane, Washington  Est. May 19, 1883
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Spokane-area hospitals post prices online under federal directive criticized as imperfect

The new federal rule requires health care providers to post prices for their procedures in spreadsheet form, part of an effort the Trump administration says is intended to improve transparency and empower consumers. But the posted figures aren’t what a patient is likely to pay out of pocket and the system isn’t user-friendly, say advocates for patients, hospitals and insurance providers.

Governor-elect commits to Medicaid expansion

Gov.-elect Brad Little said Thursday he’s committed to implementing a voter-approved expansion of Medicaid coverage but has concerns on the specifics of how it’s done.

Where they stand: Rep. Cathy McMorris Rodgers and Lisa Brown on health care, Medicare and Medicaid

Rep. Cathy McMorris Rodgers voted for a narrowly unsuccessful Republican plan to overhaul the nation’s health care system. She says it was in an effort to give states and patients more choice in their health care options. Lisa Brown, her Democratic opponent, says the bill was bad for the district and that a government option for health care is needed to help stabilize the system, while stopping short of a fully public system that dozens of the members of her party have supported.

Patti Harter: How to keep Medicare and Medicaid from going bankrupt

Bernie Sanders and other politicians have been complaining about the risk of Medicare and Medicaid going bankrupt. Concern for insolvency is certainly real. According to, it’s expected that by the year 2060 the number of Americans over the age of 65 in the United States will “double from roughly 50 million today to nearly 100 million by 2060.” ( There is, however, an evolving science called molecular biology that may hold the key to solving this problem. According to, “the science of ageing has grown in molecular detail. It is now becoming clear that changes at the levels of DNA, protein, cells and tissues all contribute to organismal ageing. Intriguingly, despite the diverse inputs, there are some common molecular themes and a few pathways and genes that have emerged as important modulators of ageing.” (

Robert J. Samuelson: The coming welfare wars

The Trump administration may have declared it over, but a new War on Poverty is coming anyways. It will be fought largely over the “work requirement” – should the government require welfare recipients either to get a job or to train for one? It’s a philosophical as much as a practical question. A work requirement addresses a dilemma of all welfare programs. If you make eligibility and benefits too generous, you destroy the incentive to work. People will just collect their welfare checks. But if the program is too stingy and strict, many genuinely needy people may lack support. A work requirement tries to disarm this dilemma by conditioning welfare benefits on having a job or training for one. There’s already a work requirement for TANF (Temporary Assistance for Needy Families). That’s traditional welfare; it mainly assists single mothers and their children. Now the Trump administration proposes work requirements for two huge programs: Medicaid, health insurance for the poor; and food stamps, now known as SNAP (Supplemental Nutrition Assistance Program). A little background. First, these programs are huge. According to a new report by President Trump’s Council of Economic Advisers (CEA), Medicaid had 71 million recipients in 2016 and cost $566 billion, counting both federal and state contributions. (The program is jointly funded.) SNAP spending in 2016 totaled $71 billion for 44 million beneficiaries. TANF is the smallest program of the group, with spending of $31 billion for 3.9 million recipients. Second, the debate over the work requirement excludes older and disabled Americans. No one is suggesting that the elderly or disabled be forced to work. The focus would be on able-bodied and non-elderly people between 18 and 64. Disability status would be determined by classification under two major disability programs: Social Security Disability Insurance (SSDI) or the Supplemental Security Income program (SSI). In 2013, reports a new CEA study, there were about 17.2 million adult Medicaid recipients who were neither disabled nor elderly. The comparable figure for SNAP was 18.6 million beneficiaries. In both cases, about half the recipients didn’t work at all and nearly another 20 percent worked fewer than 30 hours a week. This strikes Trump officials as bad and unfair. It’s bad because it isolates low-income workers from the labor market and makes it less likely that they’ll develop the skills that will enable them to improve their living standards. It’s unfair because it violates popular norms. “Society generally expects ... non-disabled working-age adults” to work, the CEA report says. At another point, the report notes: “As women’s role in the work force [has grown], so [have] social expectations of work for single mothers on welfare.” Although the report doesn’t propose a detailed work requirement, it provides enough information to imagine what one would look like. Suppose, for example, Medicaid and SNAP recipients were required to work at least 30 hours a week. Crude calculations suggest that about 25 million recipients would fall under the work requirement, though there would be some double-counting between programs. Hold it, say critics. In practice, an expanded work requirement would hurt the poor. The complexities of any program would result in people not satisfying the requirement and, as a result, losing benefits. Studies of the TANF work requirement also raise doubts about how much long-term employability of the poor improves. The CEA report, says LaDonna Pavetti of the Center on Budget and Policy Priorities, a liberal research and advocacy group for the poor, “says nothing about the realities of the low-income labor market. There’s a lot of movement in and out of jobs. Workers don’t get benefits. They can’t control their hours.” The CEA study “doesn’t acknowledge what it takes to get into the market,” she says. Workers need child care and job training – both are expensive; neither is broached extensively in the report. Moreover, some critics argue that the number of welfare beneficiaries who don’t work is overstated, because the economy has improved since 2013, when the survey data was collected. So let the political wars over welfare begin. The House of Representatives has already passed legislation imposing new work requirements for SNAP; the Senate has not. There’s plenty to argue about. Is this a problem in search of a solution? Or a solution in search of a problem? Robert J. Samuelson is a columnist with the Washington Post Writers Group

State report examines savings if Idaho were to expand Medicaid

A state-commissioned actuarial study examining the potential costs and savings of Medicaid expansion, should Idaho voters approve it in November, concluded that there could be big savings for state and local taxpayers, even if an estimated 91,000 Idahoans sign on to Medicaid — well beyond the current estimates of the 62,000 who fall into a coverage gap.