Report Shows Health Costs Far Higher In US Than
Other Countries.
The Washington Post   (3/27, Klein) "Wonkblog"
presents recently released data from the International Federation of Health
Plans (IFHP) "showing the prices that insurers are actually paying for
different drugs, devices, and medical services in different countries."
According to the blog, this year, as in all others, the "the data is
shocking." The prices, for things like scanning and imaging, routine
office visit, angioplasty, and various drugs, show that "we pay much,
much more than other countries do for the exact same things."
The Huffington Post (3/27, Young) reports further that
the IFHP data show "that average prices in the United States are higher
for most medical services cited in the report, but at the top end of the
range, US health care prices can be staggering compared to what citizens of other
nations pay."
The Los Angeles Times (3/26, Terhune) "Money &
Co." blog reported, "Even within the US, experts note that prices
vary considerably for the same medical procedure or test with little or no
difference in quality. This matters more than ever for many consumers who
face rising deductibles and higher out-of-pocket expenses on their insurance
plan."
Modern Healthcare (3/27, Evans, Subscription
Publication) sums up the report: "Private insurers in the US last year
paid significantly more - up to 26 times as much in one case - for common
procedures, hospital and doctor visits, and prescriptions when compared with private
and public insurers in 10 other countries."
Study Finds California Is Sixth
Lowest In Healthcare Spending.
On its
"Capitol Alert" blog, the Sacramento (CA) Bee (3/27, Walters) reports that
"health care has become, by most measures, the largest single piece of
the California economy, well over 10 percent of its $2 trillion output of
goods and services - and destined to grow as the state extends medical
insurance coverage to millions of Californians under the federal Affordable
Care Act." A new study by the National Center for Policy Analysis,
however, found that "as large as it may be, the health care spending in
California has been relatively small, compared to other states." The
study "found that as of 2009, the latest year for which complete data
were available, California was sixth lowest among the states in public and
private health care spending as a proportion of its economy."
California Measure Would Let Insurance Commissioner Reject Rate
Hikes. In his column for the Los Angeles Times (3/27), Michael Hiltzik writes that
California health insurers are preparing to fight a ballot initiative that
would give the state Insurance Commissioner the power to reject health
insurance premiums deemed to be too high. Noting that the initiative will
appear on the November 2014 ballot Hiltzik writes, "That's an
unconscionably long time to wait for a crucial piece of the health insurance
reform jigsaw, but on the plus side, if it passes it will be retroactive to
last November." Hiltzik adds that "insurers and other contributors
assembled a war chest of more than $650,000 by the end of last year to fight
the 2014 initiative."
Former House Chairman: Congress
Should Let Medicare Negotiate Drug Prices.
In the
Bangor (ME) Daily News (3/26), John Brautigam, former
House chairman of the Legislature's Insurance and Financial Services
Committee, writes that "it's never too late for Congress to save money
in ways that would do no harm to our people or our economy." For example,
he writes, "Congress could start by taking a look at the role
prescription drug manufacturers play in serving the 35 million Americans with
Medicare drug benefits." Brautigam argues, "Let's hope all of
Congress finds the political will to stand up for taxpayers and do the
sensible thing. Congress should let Medicare do what any business in the
private sector would do - negotiate drug prices."
McConnell Urges House To Pass
Medical Device Tax Repeal.
Roll Call (3/27, Goddard, Subscription
Publication) reports that Senate Minority Leader Mitch McConnell (R-KY)
"is calling on the House to send over legislation to repeal the health
care law's tax on medical devices, following a bipartisan vote among senators
in favor of such a move last week." McConnell "said he thought
House Republicans should pass a stand-alone repeal of the medical-device tax
to see how the Senate would handle it." McConnell noted that while the
Senate vote repealing the device tax "was non-binding, it signaled
overwhelming support that could box in Democrats down the road."
Local Device Companies Likely To Be Hurt By Tax. The Boston Business Journal (3/27, Seiffert, Subscription
Publication) "Bioflash" blog reports that the "19 biggest
medical device companies" in Massachusetts "will pay an estimated
$411 million this year for a new federal excise tax to help pay for ObamaCare,
according to research by the Pioneer Institute." According to the study,
"those costs will result in higher costs at some companies that make
products ranging from pacemakers to surgical tools, and reduced research
expenses or employee growth at others."
The Kansas City (MO) Business Journal (3/27, Pfannenstiel, Subscription
Publication) reports further on the medical device tax, noting that
"Kansas City is home to a small but growing medical device industry.
Since 2009, the number of medical device companies in the region has grown by
nearly 56 percent, from 34 to 53 companies."
Forbes Columnist: Insurers
Responsible For "Rate Shock" Controversy.
Forbes (3/27) contributor Rick Ungar
discusses the "unfounded" claim by insurance lobbyists that the
Affordable Care Act will result in "dramatically larger premium costs
for a significant number of Americans." He explains that the Urban Institute
recently released a study disputing this so-called "rate shock,"
and that "the lowered premium costs to the oldest participants in an
insurance plan 'would have very little impact on out-of-pocket rates paid by
the youngest nongroup purchasers.'" Ungar concludes, "As The Urban
Institute study makes crystal clear, the 'rate shock' controversy has far
more to do with insurance company lobbying efforts and far less to do with
the reality of what health insurance will cost for millions of young
Americans."
Public Health and Private
Healthcare Systems
Across US, Medicaid Expansion Decisions Progress.
Coverage
of Medicaid expansion across the US continues, with accounts of a study and a
bill joining the regular locally-focused reports. Six Republicans introduced
a bill to repeal Medicaid expansion Tuesday, the same day an Urban Institute
study was released showing that veterans across the country would benefit
from expanding the program. States receiving significant coverage include
Tennessee, where Governor Bill Haslam is expected to announce his decision
Wednesday, and Virginia, where Governor Bob McDonnell tweaked the General
Assembly's bill governing expansion. Beyond that, several pieces touched upon
the so-called Arkansas alternative to expansion.
House Republicans Introduce Bill To Repeal Medicaid Expansion. The Hill (3/27, Kasperowicz) "Floor
Action" blog reports that Representative Matt Salmon (R-AZ), along with
five other House Republicans, "have introduced legislation that would
repeal the 2010 expansion of Medicaid benefits to lower-income
Americans." According to Salmon, the Affordable Care Act "'essentially
bribed states' to expand Medicaid eligibility to people with incomes at 138
percent of the poverty level." On Monday, Salmon said, "Medicaid
needs reform, not expansion. Instead of more federal mandates, I support
giving states the maximum flexibility to provide services to their most
vulnerable populations."
Study Finds Vets Could Benefit In States That Expand Medicaid
Under ACA. The Hill (3/27, Viebeck)
"Healthwatch" blog reports on a new analysis from the Urban
Institute which found that "veterans stand to benefit substantially from
President Obama's healthcare law, particularly in states that choose to
expand their Medicaid programs." According to the study, "as many
as 40 percent of uninsured US veterans would be eligible for healthcare under
the law's insurance exchanges or its expanded Medicaid program."
Currently, "there are currently about 1.3 million uninsured veterans,
the report said, but fewer than half of those who would qualify under broader
Medicaid eligibility live in states that will accept the expansion."
Government Health IT (3/27, Brino) reports that the
study explains, "With only nine states offering comprehensive Medicaid
coverage to nondisabled, nonpregnant adults without dependent children and
with as many as 25 states possibly opting out of Medicaid expansion, several
hundred thousand veterans could end up struggling to find coverage."
The Charleston (WV) Gazette (3/27, Kersey) reports that,
according to the study, West Virginia "officials could nearly cut in
half the number of uninsured veterans in West Virginia by expanding Medicaid
coverage to those who make up to 138 percent of the federal poverty
line." Noting that "West Virginia has an estimated 11,300 uninsured
veterans," the report indicates that "expanding Medicaid under the
Affordable Care Act would mean that 5,300 of them would get medical
coverage" and "another 2,600 uninsured military spouses in the
state would also be covered under Medicaid expansion."
Similarly, the Arizona Republic (3/27, Reinhart) reports that in
Arizona, 11,000 veterans are uninsured. And, according to the study, 2,000
would be eligible for Medicaid if the state agrees to expansion.
Haslam Expected To Announce Tennessee Medicaid Expansion
Decision Wednesday. The AP (3/27, Schelzig) reports that
Tennessee Governor Bill Haslam will announce his decision about Medicaid
expansion at a joint session of the General Assembly Wednesday, according to
an official "familiar with the plans." Lawmakers "plan to authorize
the gathering during regular floor sessions Wednesday morning, the official
told The Associated Press on the condition of anonymity because the joint
assembly hadn't yet been publicly announced." Though no confirmation was
given, "Haslam's spokesman recommended reporters attend the House floor
session at 9:30 a.m. CDT." So far, there is no word what Haslam's
decision will be.
The Chattanooga (TN) Times Free Press (3/27, Sher) reports, "For
months, Haslam has been struggling with whether to extend TennCare to an
estimated 181,000 low-income people. Earlier this week, Haslam said he would
make a decision this week. If Haslam says yes to the expansion, he faces
opposition among any number of fellow Republicans in the Legislature."
The Nashville Scene (3/27, Hale) also reports on
Haslam's anticipated announcement.
The Nashville (TN) Business Journal (3/27, Boyer, Subscription
Publication) "BizBlog" reports that ahead of Haslam's decision,
"the Tennessee Chamber of Commerce & Industry, which has remained
relatively mum on the matter, has voiced its support for a TennCare expansion,
provided the expansion is reevaluated after the initial three-year period,
which is when state funding for the expansion would begin to kick in."
McDonnell Slightly Alters Virginia Medicaid Expansion Language. The AP (3/27, Lewis) reports that Virginia
Governor Bob McDonnell has offered amendments to several bills currently in
the state's General Assembly, including one "clarify[ing] requirements
for expanding Medicaid in Virginia." McDonnell Monday night "signed
727 bills into law, amended 80 and vetoed six." The House and Senate
"reconvene for a single day on April 3 to consider McDonnell's actions
on this year's legislation. A majority of 51 delegates in the 100-member
House and 21 members of the 40-seat Senate is necessary to reject a
gubernatorial amendment, but two-thirds majorities in each chamber are
required to override a veto."
The Richmond (VA) Times-Dispatch (3/27, Martz) reports that the new
Medicaid language "is more specific about the reforms that would be
required before a new legislative commission would sign off on expansion, but
the governor is not requiring changes in federal law that the state could not
attain, as he has sought before." Further, it "does not make
significant changes to address concerns that [Attorney General Ken]
Cuccinelli raised about the constitutionality of delegating authority to the
new commission to expand the program. But administration officials said the
new language leaves less discretion to legislators on the commission in
determining whether reforms are sufficient to justify expanding the
program."
The Newport News (VA) Daily Press (3/27, Wilson) explains that
"on Friday Cuccinelli issued a legal opinion that said the regional
component that included additional sales taxes for Hampton Roads and Northern
Virginia was unconstitutional because it would in effect be the General Assembly
writing local law." And, "in a separate opinion, he said the budget
deal that creates a commission of 10 lawmakers that will assess reforms to
the state's existing Medicaid program before approving an expansion of the
program under the federal Affordable Care Act was unconstitutional because
the General Assembly is not allowed to cede its legislative authority to a
committee or commission."
Move To Debate Medicaid Expansion In Idaho Rebuffed By
Republicans. The AP (3/27) reports that "minority
Democrats are demanding Republicans schedule debate on a bill to expand
Medicaid this session, saying Idaho risks squandering an opportunity to save
taxpayers tens of millions and bring $1.1 billion into the state." In an
open letter, House Minority Leader John Rusche (D-ID) joined Sen. Dan Schmidt
(D-ID) in "urging Republicans to 'find courage to stand up to their
activists' narrow, but vocal opposition." Although Rep. Tom Loertscher
(R-ID) "has introduced a measure to expand Medicaid, arguing it makes
financial sense," the AP notes that "Republican leaders including
House Speaker Scott Bedke say there's not enough time left in the 2013
session to tackle the issue."
The Twin Falls (ID) Times-News (3/27) notes that Bedke "said
last week the 2013 Legislature won't consider Medicaid this year, but waiting
a year will change the politics of the issue entirely. Next year is an
election year, and lawmakers may be wary of voting on a controversial Obamacare-related
issue in the spring when faced with a May primary challenge from within their
own party." However, freshman House members Luke Malek (R-ID) and Robert
Anderst (R-ID) "said they wouldn't let threats of primary challenges or
donations to opponents sway their votes."
On its website, KTVB-TV Boise, ID (3/27) reports that
Rusche's effort to schedule a hearing "failed 2-8, with no Republican
support." Rusche stated: "Some of it is healthcare fatigue through
the legislative session, and some of it is concern about having to address
another aspect of the Affordable Care Act, or Obamacare, and some of it is
really lack of understanding, I think, of the real benefits and the
implications of failing to make a decision at this point in time."
KTVB-TV adds that "Rusche says they don't plan to do anything more
aggressive this session, though he still wishes Republicans would
reconsider."
Missouri House Defeats Bid To Expand Medicaid. The AP (3/27, Lieb) reports that
"Missouri's Republican-led House dealt a resounding defeat Tuesday to
Democratic attempts to expand Medicaid, refusing to add more than $900
million to the state budget to cover 260,000 lower-income adults because of
concerns about a future drag on state finances." The AP adds that
"the largely party-line votes against the Medicaid expansion marked the
climax of a daylong House debate on Missouri's budget but were almost a
foregone conclusion" after "various Republican-led House and Senate
committees have repeatedly voted down the Medicaid enlargement over the past
several weeks." The AP notes that, "despite the Republican
rejection," Gov. Jay Nixon "continued to travel the state Tuesday
trying to build public support for a Medicaid expansion as called for under
the" ACA.
On her "Political Fix" blog in the St. Louis Post-Dispatch (3/27), Elizabeth Crisp writes
about the vote, noting that "Republicans in the chamber repeated their
concerns - that expansion will add too much of a burden to federal expenses,
that the federal government can't be counted on to hold up its end of the expansion
plan and that, ultimately, an expansion could create a burden on other areas
of the state budget, including education." Crisp adds that, "for
their part, House Republicans have been pushing alternative efforts that
include Medicaid reforms, but the only incarnation of that, a proposal
sponsored by Rep. Jay Barnes, R-Jefferson City, was not counted in the budget
bills approved today."
The Springfield (MO) News-Leader (3/27, Shorman) reports that
"the Medicaid debates provided moments of drama on the first day of a
weeklong process to pass the 13 House appropriations bill, which fund the
state government."
Montana House Endorses Medicaid Expansion Bill. The Helena (MT) Independent Record (3/27) reports that "the
Republican majority in the state House Monday endorsed a bill that would
study, rather than enact, a Montana expansion of Medicaid, the government
health-care program for the poor." Rep. Cary Smith (R-MT), who sponsored
House Bill 604, stated: "This (bill) would form a group to look the next
couple of years to decide what's right for Montana. I think this is something
we need to take the time to look at." The Independent Record adds that
"the House voted 54-46 to endorse Smith's bill, which then was sent to
the House Appropriations Committee for another hearing on Tuesday."
On its website, KBZK-TV Butte, MT (3/27) reports that
"more than 100 people rallied at the Capitol on Monday to show support
for" Gov. Steve Bullock's "Access Health Montana" bill, which
"would expand Medicaid to 70,000 more people."
Arkansas' Approach To Medicaid Expansion May Prove More
"Palatable" To Conservative States. On the
NPR (3/27, Messick) website, reporter
Molly Messick writes in "StateImpact" that "Idaho lawmakers
took more than 15 hours of floor debate during this legislative session to
determine that Idaho should create a state-based health insurance exchange.
It was an act of compliance with the federal health care law that raised the
hackles of many conservative Idaho lawmakers." NPR highlights the move
toward a "third option," after HHS gave the Arkansas permission
"to use federal Medicaid expansion money to purchase private health
insurance plans." NPR notes that the option is "a middle path that
could prove more palatable in conservative states like Idaho that have so far
held off on coming to a decision, or rejected the option to expand Medicaid
eligibility to 138 percent of the federal poverty level."
One state considering following the Arkansas approach is Louisiana. As the AP (3/27) reports, "lawmakers
urged Gov. Bobby Jindal's health department Tuesday to look at alternative
program models to tap into the Medicaid expansion money available under the
federal health care law." The AP notes that "the issue came up
several times during a House Appropriations Committee review of next year's
budget for the Department of Health and Hospitals, which doesn't include the
anticipation of any dollars from the Medicaid expansion." Rep. Walt
Leger (D-LA) "asked DHH Undersecretary Jerry Phillips to track
negotiations in Arkansas, which asked federal officials to let it use the
Medicaid money to buy private insurance policies."
Similarly, the Dayton (OH) Daily News (3/27, Tucker) reports that
"Ohio Gov. John Kasich is negotiating a plan with the federal government
to use the money originally intended to expand Medicaid eligibility to about
366,000 Ohioans to instead buy private insurance for new enrollees on state
health exchanges expected to go on-line in October." The Daily News
notes that "the money would be used help pay premiums on the health
exchanges, officially called Health Insurance Marketplaces, for low-income
people at or below 138 percent of the federal poverty rate, or about $15,400
for an individual or $32,000 for a family of four in annual earnings."
Ohio Medicaid Director John McCarthy stated: "It's something that we
have been talking to (the Centers for Medicare & Medicaid Services) about.
No deal is done. We're just exploring whether it's technically possible to do
this, and how, specifically, would it work."
Beebe Calls For Medicaid Expansion In Arkansas. The Arkansas Democrat Gazette (3/26, Lesnick) reported that
Arkansas Gov. Mike Beebe, speaking before the Little Rock's Regional Chamber
of Commerce Tuesday, warned that difficult cuts are likely if the state legislature
fails to expand Medicaid, but moves to approve revenue tax cuts. Beebe
stated: "If you don't pass Medicaid expansion and you do [pass] those
tax cuts, you better figure out and realize who you're hurting and make that
conscious decision on the front end and then live with the
consequences." Calling Medicaid expansion in Arkansas an "uphill
battle," Beebe highlighted the potential affects such cuts would have on
the University of Arkansas for Medical Sciences.
In a blog post in the Arkansas Times (3/26), columnist Max Brantley
wrote about a Twitter debate he had with Sen. Jason Rapert (R-AR) about the
popularity of the ACA and its eventual acceptance by Arkansas Republican
legislators. Rapert tweeted: "The insanity of Obamacare mandate is mind
boggling. May voters rid this nation of every Democrat that voted this junk
into law!" However, Brantley noted that, when pressed, Rapert failed to
"declare forthrightly" his stance on Medicaid expansion in
Arkansas. Brantley asserted: "It seems more likely he's pre-spinning a
pro-Obamacare vote."
Mississippi Governor Expected To Call Special Session To Address
Medicaid Expansion. In the Memphis (TN) Commercial Appeal (3/27), columnist Phil West writes
that Mississippi "legislators and Gov. Phil Bryant likely will resolve
the conflict over whether to expand Mississippi's Medicaid program under the
federal Affordable Care Act"; however, officials say "it won't
happen before legislators end their 2013 session on April 7." House
Speaker Philip Gunn (R-MS) "said Tuesday he believes that Bryant, who
bitterly opposes expanding the federal-state health care program for the poor
and disabled, will call a special legislative session to deal with
Medicaid."
Report Finds Medicaid Expansion Could Cost Louisiana Almost $2B
Over Ten Years. In other Louisiana news, the New Orleans Times-Picayune (3/27, McGaughy) reports that,
according to an analysis released Tuesday from the Department of Health and
Hospitals, "opting into Medicaid expansion could cost the state of
Louisiana almost $2 billion over 10 years - or it could save the state more
than $367 million in the same period." The report, which "provides
three separate analyses for how the expansion of Medicaid in Louisiana could
affect state coffers," indicates that "the unpredictable nature of
expanding the federal program under the Affordable Care Act makes the idea
'risky.'" Louisiana Budget Project policy analyst Steve Spires said
"that the DHH report reiterates LBP findings released in February that
showed the expansion would likely result in savings because more low-income
uninsured residents would be covered, thereby not using the state charity
hospital system."
In a second article, the New Orleans Times-Picayune (3/27, Maggi) reports that
"the DHH report mirrors other recent analyses of the Medicaid expansion
from outside organizations like the Kaiser Family Foundation, the Urban
Institute and the Louisiana Budget Project. All of the reports came up with
much lower price tags for the expansion than the original $3.7 billion cost
repeatedly cited by Jindal administration officials this summer and
fall." The Times-Picayune adds that, "although the report finds
that taking the Medicaid expansion could be advantageous for Louisiana's
budget, the report still cautions that the federal insurance program for the
poor needs to be reworked by the US Department of Health and Human
Services."
NFIB Launches Ad Campaign Against Medicaid Expansion In Florida.
The Orlando (FL) Sentinel (3/27) reports that "the
National Federation of Independent Businesses - which bills itself as 'The
Voice of Free Enterprise' - has begun an ad campaign urging Florida
legislators not to opt for Medicaid expansion under the Affordable Care
Act." Although "legislators have pretty much decided not to accept
the Obamacare expansion of Medicaid, senators have said they do want to grab
the $51 billion in federal money that's available over the next 10 years, at
a cost to the state of $3.5 billion." The Sentinel notes that "the
NFIB ad plays on fears... that the feds won't be able to make good on their
promise to pay because of soaring deficits."
The Palm Beach (FL) Post (3/27, Kennedy) reports that
"NFIB challenges whether Florida can rely on the promise that Washington
will be there with the money if Medicaid expands. The organization also is
trying to get Floridians to sign petitions opposing expansion."
Lawmakers: Hospitals Could Lose Millions If Kansas Fails To
Expand Medicaid. The Wichita (KS) Eagle (3/27, Wistrom) reports that,
according to lawmakers, "hospitals large and small that serve people who
don't have insurance could lose millions if the state doesn't expand Medicaid
under the Affordable Care Act, and the state is poised to not expand."
In order "to help buffer a potential dropoff in federal
'disproportionate share money' for hospitals that help the uninsured,"
Sen. Jim Denning (R-KS) "is pushing to at least keep up with the state
part of that funding to provide 'a soft landing.'" Although "the
roughly $76 million in state and federal money is intended to help safety net
clinics take care of people who don't have insurance," the Eagle notes
that "lawmakers say they think federal funding will drop significantly,
if not be eliminated, as funding shifts to Medicaid expansion."
Maine Governor Urged To Accept Medicaid Expansion. The AP (3/27, Adams) reports,
"Mainers who fear that time is running out on their health care coverage
urged Gov. Paul LePage on Tuesday to accept an expansion of Medicaid that's
being offered under the federal health care overhaul. The Maine People's Alliance
delivered paper copies of 2,500 messages that it collected on its Web site
after a news conference in which speakers gave personal accounts of why they
need coverage through Medicaid."
"Medicaid Madness Tour" To Stop In Mason City, Iowa. The Mason City (IA) Globe Gazette (3/27) reports, "A 'Medicaid
Madness Tour' to educate Iowans about the need to expand Medicaid coverage in
the state will include a stop in Mason City on Wednesday, March 27. ... Chris
Petersen of the Iowa Main Street Alliance will talk about the benefits of
expanding Medicaid to an additional 150,000 Iowans, including young adults,
veterans, the working poor and mentally ill."
Report Criticizes Minnesota's
Oversight Of MinnesotaCare Eligibility.
The Minneapolis Star Tribune (3/27, Schrade) reports,
"Minnesota has failed to properly vet people enrolling in a $550 million
taxpayer-subsidized health insurance program despite a decade of warnings
that it was breaking state and federal law, according to the Legislative
Auditor." A newly released report from Legislative Auditor Jim Nobles
suggests that "the Department of Human Services (DHS) has known for
years it was failing to properly verify the income and Social Security
numbers of applicants for MinnesotaCare."
Minnesota Public Radio (3/26, Stawicki) reports, "The
Legislative Auditor's report finds DHS did not adequately verify that
information provided by participants in its MinnesotaCare insurance
program." Additionally, "the auditor...found DHS did not adequately
monitor how county workers resolved discrepancies when income amounts
reported by participants did not match government data in other programs such
as Medical Assistance; Temporary Assistance for Needy Families, and
Supplemental Nutrition Assistance programs."
According to the St. Paul Pioneer-Press (3/27), "Human Services
Commissioner Lucinda Jesson said she agrees with the auditor's findings and
that the state is building a new computer system to verify eligibility as
part of the new health insurance exchange."
Advocacy Groups: Medicare Cuts Would Undermine
Small Business Owners' Retirement Plans.
The Newark (NJ) Star-Ledger (3/27, Jones) reports that
according to a report by Social Security Works and The Main Street Alliance,
"if the budget battle in Congress results in cuts to Social Security or
Medicare, it would undermine small business owners' retirement plans and weaken
consumer demand for goods, according to a report by two national advocacy
groups." The report stated, "Even a 3 percent cut in Social
Security benefits would take $638.3 million out of New Jersey's economy. A
similar cut to Medicare, meanwhile, would cost New Jersey's economy $465.8
million. Such cuts are the last thing struggling small businesses need in the
midst of a fragile economic recovery."
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