Showing posts with label medicare. Show all posts
Showing posts with label medicare. Show all posts

Wednesday, January 26, 2011

Libertarian response to State of the Union and Republicans

This evening (January 25), Libertarian Party Executive Director Wes Benedict spoke in response to the addresses from President Barack Obama and Congressman Paul Ryan.

A transcript of Mr. Benedict's speech follows:

Good evening and thank you for your interest in the State of our Union.

My name is Wes Benedict. I'm the executive director of the Libertarian National Committee here in Washington, DC. The Libertarian Party stands for free markets, civil liberties, and peace.

Tonight we heard from President Barack Obama and a response from Republican Congressman Paul Ryan.

President Obama says he wants a freeze in non-security, discretionary spending. In the unlikely event that happens, it won't really matter, because to make a real dent in the deficit, it's necessary to cut spending on the military and entitlements. The president promised big government in the past, and he delivered. I expect more of the same.

However, Obama has truly been a hypocrite on the wars in Iraq and Afghanistan. As a candidate, he promised to end them. Tonight we heard more hollow promises. The fact is, as president, he has kept those wars going, and has greatly escalated the war in Afghanistan. As a percentage of GDP, military spending is higher now than it was during any year of the George W. Bush administration.

Unlike President Obama, Libertarians would bring our troops home from Iraq and Afghanistan, and reduce the military budget.

On the Republican side, I found Congressman Paul Ryan's hypocrisy appalling. He claims to want big cuts in government spending. But he didn't seem to be too worried about cutting spending when Republicans were in charge. He supported the huge Medicare expansion in 2003, and the expensive No Child Left Behind Act in 2001. He supports the expensive War on Drugs. In 2008, he put hundreds of billions of taxpayer dollars at risk by voting for the massive TARP bailout, and he even voted to spend billions on the GM and Chrysler bailout.

Just one month ago, Congressman Ryan voted for the tax compromise that included a big increase in unemployment spending, and even extensions of government spending on ethanol.

Republicans don't want to cut spending -- they want to talk about cutting spending.

Congressman Paul Ryan is a perfect example of why Republicans are bad for America.

Republicans' plans for Social Security and Medicare are little more than a distraction. It's time for someone to have the guts to tell seniors the truth: You were promised way too much, and now we've got to make major cuts. I'm asking retirees to think about the enormous debts piling up on your children and grandchildren.

Libertarians would stop spending billions on bailouts, the War on Drugs, federal education programs, and we would end mandatory Social Security and Medicare.

Today, America is a country that attracts hardworking immigrants from Mexico and around the world, leaving countries that are less free and prosperous. Libertarians welcome these immigrants warmly. But I often wonder if -- in 20 years -- America will still be a great place to live, or if it will be another declining civilization fraught with poverty and abuse that your children want to leave.

The future of America may depend on the Libertarian Party steering us towards liberty and away from tyranny.

The Libertarian Party is America's third-largest party, and one of the most successful alternative parties in American history.

We are recruiting bold, principled men and women dedicated to freedom to fill leadership positions and to run for office as Libertarians.

You don't have to agree with every single Libertarian position to join the Libertarian Party. You can still make a difference and help us move our country towards freedom.

The Libertarian Party has more information at our website, LP.org. Please visit LP.org and join the Libertarian Party today.

Thank you and good night.

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Monday, November 29, 2010

Pelosi Statement on Passage of the Physician Payment and Therapy Relief Act

/PRNewswire/ -- Speaker Nancy Pelosi issued the following statement today after the House passed bipartisan legislation blocking the 23 percent cut in Medicare payments to doctors, scheduled for December 1, for one month, while a longer-term fix is negotiated. The Senate passed the bill on November 18, and it now goes to President Obama for his signature into law:

"Today, the House of Representatives acted to ensure that America's seniors and military families can continue receiving the care they need and deserve from their doctors. This fully paid-for legislation provides doctors with the stability and support to continue providing vital services to all of their patients in the Medicare and TRICARE systems for the next month, while leaders from both parties work together on a longer-term solution before we adjourn.

"In taking this vote, Members of Congress have taken a clear stand on the side of seniors, service members, and the physicians and medical professionals who treat them."

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Tuesday, June 8, 2010

HHS Secretary Kathleen Sebelius and U.S. Attorney General Eric Holder Send Letter to State Attorneys General On New Outreach and Education Efforts to Combat Medicare Fraud

U.S. Secretary of Health and Human Services Kathleen Sebelius and Attorney General of the United States Eric Holder today sent a letter to state attorneys general urging them to work with HHS and federal, state, and local law enforcement officials to mount a substantial outreach campaign to educate seniors and other Medicare beneficiaries about how to prevent scams and fraud beginning this summer. The outreach campaign is another step in the ongoing work of the Health Care Fraud Prevention Enforcement Action Team (HEAT), a cabinet-level initiative launch by HHS and DOJ in May 2009.

“We are heading into the week when our first tax-free $250 donut hole rebate checks will be mailed out to Medicare beneficiaries who have fallen into the coverage gap. Accordingly, we are especially concerned about fraud and increased activity by criminals seeking to defraud seniors – and we are seeking your help to stop it,” said Secretary Sebelius and Attorney General Holder in the letter. “Building on our record of aggressive action, we will use the new tools and resources provided by the Affordable Care Act to further crack down on fraud.”

In the letter, the Secretary and Attorney General outline education and outreach efforts where state attorneys general could make a big difference. These include efforts to cut the improper payment rate, which tracks fraud, waste and abuse in the Medicare Fee for Service program, in half by 2012; a series of regional fraud prevention summits around the country over the next few months; regular health care fraud task force meetings to facilitate the exchange of information with partners in the public and private sector, and to help coordinate anti-fraud effort; HHS’s plans to double the size of the Senior Medicare Patrol and to put more boots on the ground in the fight against Medicare fraud; and a new educational media campaign this summer to educate Medicare beneficiaries about how to protect themselves against fraud.

The full letter follows.


June 8, 2010

Dear Attorney General:

It was a pleasure to have the opportunity to speak with you and your staff a few weeks ago. We wanted to send you a letter summarizing our discussions and following up with some suggestions of ways we can work together to protect the American people from health care fraud.

In the two months since the Affordable Care Act was signed into law, we have made substantial progress on providing better choices for consumers, tackling health care costs, and holding insurance companies accountable. But while we have been hard at work, scam artists and criminals continue to profit from misinformation about the Affordable Care Act.

Since early April, we have heard increasing reports about seniors being asked to provide their Social Security numbers in order to receive a “donut hole” check under the new law, raising concerns about potential identity theft scams. We have fielded consumer complaints about phony insurance policies, and our Senior Medicare Patrols have been receiving a growing number of calls from people across the country reporting potential fraud schemes.

We are heading into the week when our first tax-free $250 donut hole rebate checks will be mailed out to Medicare beneficiaries who have fallen into the coverage gap. Accordingly, we are especially concerned about fraud and increased activity by criminals seeking to defraud seniors – and we are seeking your help to stop it.

The President has asked us to reach out to you and to other federal, state, and local law enforcement officials across the country to mount a substantial outreach campaign to educate seniors and other Medicare beneficiaries about how to prevent scams and fraud. Some important components of these outreach and education efforts, where you and your staff could make a big difference, are described below.

First, the President has directed the Department of Health and Human Services (HHS) to cut the improper payment rate, which tracks fraud, waste and abuse in the Medicare Fee for Service program, in half by 2012.

Second, following on the National Health Care Fraud Summit we co-hosted in Washington earlier this year, the President has asked both our Departments to convene a series of regional fraud prevention summits around the country over the next few months. The first summit will take place in Miami on July 16. Other summits will follow in, for example, Los Angeles, Las Vegas, Detroit, Boston, New York, and Philadelphia.

These summits will bring together top federal and state officials; representatives of federal, state, and local law enforcement; representatives of our agencies; the health care provider community, such as hospitals and doctors; local businesses; the Senior Medicare Patrol; caregivers; and seniors, for a day of panels and training sessions. Your expertise and experience will be instrumental to the success of these events.

Third, at the Attorney General’s request, the Acting Deputy Attorney General has sent a memo to every United States Attorney in the country asking them to convene regular health care fraud task force meetings to facilitate the exchange of information with partners in the public and private sector, and to help coordinate anti-fraud efforts. Most of these meetings will be held quarterly, with some exceptions for smaller districts. All 93 U.S. Attorneys have been asked to put a plan into place and schedule their first meeting by August 16, 2010. We hope that you and your office will take part in these regular exchanges on effective fraud fighting strategies.

Fourth, HHS will be doubling the size of the Senior Medicare Patrol and putting more boots on the ground in the fight against Medicare fraud. Since 1997, HHS and its Administration on Aging have funded Senior Medicare Patrol projects to recruit and train retired professionals and other senior citizens about how to recognize and report instances or patterns of health care fraud. Close to three million Medicare beneficiaries have been educated since the start of the program, and more than one million one-on-one counseling sessions have taken place with seniors or their caregivers. Currently, the Senior Medicare Patrol program funds projects in every state, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands.

Fifth, the Centers for Medicare & Medicaid Services, in conjunction with the Administration on Aging, will be launching an educational media campaign this summer to educate Medicare beneficiaries about the importance of staying vigilant with their personal Medicare information and getting the facts out about the new law so that scam artists are not able to prey on seniors.

The more we can educate the American people about fraud prevention, the better chance we have to protect taxpayer dollars and the Medicare trust fund. The Affordable Care Act also contains some important new tools and resources that will directly help law enforcement officials crack down on fraud.

As you are well aware, fraud schemes have plagued public and private health care plans for decades. Fraudsters have been stealing billions of dollars a year from Medicare, Medicaid, and private health insurers. A year ago, our Departments joined forces to combat fraud in federal health programs. Through the establishment of the Health Care Fraud Prevention Enforcement Action Team (HEAT), we have expanded special anti-fraud Medicare Fraud Strike Forces into seven cities, developed sophisticated new techniques of fraud prevention data analysis, and redirected program integrity resources to fraud hot spots.

Building on our record of aggressive action, we will use the new tools and resources provided by the Affordable Care Act to further crack down on fraud. These include new criminal and civil penalties, enhanced information technology to track and prevent fraud in the first place, and new authorities to prevent bad actors from billing Medicare and Medicaid. HHS has already issued the first set of fraud prevention regulations required under the new health law. These regulations strengthen provider enrollment requirements to ensure we have the ability to better identify, screen, and audit providers and claims.

As we do our part in Washington, we want to work closely with you and other state officials to fight fraud. In that vein, the Affordable Care Act also strengthens state officials’ ability to detect and root out Medicaid fraud. For example, the law provides new access to Medicaid data for the Secretary of HHS that will help both states and the Administration to coordinate anti-fraud activities and gives states greater incentives and flexibility in identifying and collecting Medicaid overpayments. It also helps to promote enhanced information technology to track and prevent fraud, including predictive modeling techniques that can identify abusive or fraudulent billing patterns, audits, and a shared provider database for pre-enrollment screening and post-enrollment anomaly monitoring.

Securing health care coverage, affordability, and choices for Americans requires hard work and vigilance. We stand ready to serve as a resource and partner for you as we work together to fight fraud, implement the provisions of the new health reform law, and strengthen our health care system.

Sincerely,

Eric Holder
Attorney General

Kathleen Sebelius

Secretary of Health and Human Services

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Wednesday, May 26, 2010

Pelosi: 'We Passed Health Reform to Improve Medicare and Ensure Seniors Can Count on It Now and for Generations'

/PRNewswire/ -- Speaker Nancy Pelosi, Health and Human Services Secretary Kathleen Sebelius, House Majority Leader Steny Hoyer, Barbara Kennelly of the National Committee to Preserve Social Security and Medicare, and Dr. Ben Williamowsky of Silver Spring, Md., a Medicare recipient, held a news conference today to discuss benefits of and misconceptions about the Affordable Care Act and Medicare.

The participants highlighted a four-page brochure, "Medicare and the New Health Care Law, What it Means for You," which was mailed by HHS this week to seniors. It outlines the benefits for Medicare recipients in the new health insurance reform law.

Below are Speaker Pelosi's opening remarks and selected quotes from each of the other participants:

Speaker Pelosi Opening Remarks:
"Good afternoon. I know you are out there. [Laughter.] Good afternoon.


"And a good afternoon it is when we have the Secretary of Health and Human Services with us at the Capitol--Secretary Kathleen Sebelius, a champion in promoting health care for all Americans as a right, not a privilege. I am here with Majority Leader Steny Hoyer. A special guest for all of us, Dr. Ben Williamowsky, a retired dentist and local senior. Steny will introduce him, but I want to say that my father gave him his diploma from dental school in 1948. Where is he? There. We go way back. [Laughter.]

"Four decades ago, Congress created Medicare, a bedrock promise to our seniors. This year, we passed health care reform to improve Medicare, to protect seniors and people with disabilities, and to ensure that seniors can count on Medicare now and for generations to come.

"We are here to draw attention to a critical piece of mail our seniors will get this week. This four-page brochure outlines the new benefits in health reform for Medicare recipients. There it is.

"Perhaps most significantly it begins with what stays the same for Medicare. No change in guaranteed benefits and no change in eligibility. During open enrollment this fall, seniors will continue to have a choice between original Medicare and Medicare Advantage. Medicare will continue to cover health cost the way it always has for seniors. Barbara Kennelly is here, our former colleague, to attest to that.

"Members of Congress will head home to their districts this weekend for Memorial Day. One of our top jobs is to clear up confusion and correct misinformation around health reform. This brochure for seniors is a good place to start.

"We also have to make clear that Congressional Republicans calling for repeal also oppose those benefits and would return us to a system of higher drug cost, shrinking benefits, and insecurity for our seniors. In fact, they have a budget--that's the nature of their budget--that ends Medicare as we know it and turns Social Security over to the whims of Wall Street.

"Republicans in Congress chose the side of the insurance industry and its profits, over the care of what seniors need and deserve. Democrats have been on the side of America's seniors -- securing Medicare for the long-term, ensuring accountability for the insurance industry -- accountability for the insurance industry -- and giving seniors, families, and doctors greater control over their care.

"It is now my honor, as I mentioned earlier, to introduce a great woman who is with us today. And I mention that my father gave Dr. Williamowsky his diploma in 1948. I want to mention that Barbara Kennelly, former Congresswoman, now the head of the Committee to Preserve Social Security and Medicare, and Kathleen Sebelius and I are all graduates of Trinity College in Washington, D.C. -- a women's college in Washington, D.C. And we all had fathers in politics -- the governor of Ohio, the mayor of Baltimore, and Mr. Bailey, the king of the Democratic Party in Connecticut and nationally, as a matter of fact. We had fathers who encouraged their daughters. I hope that there is a message here.

"Again, now, it's my honor to yield the floor to the distinguished Secretary of Health and Human Services. As governor -- as insurance commissioner in her home state of Kansas, as governor of the state -- she knows the ramifications and the implications of legislative language very well. As a person with a vision for health care for all Americans, she is an inspiration to all of us and a major reason why we were able to pass that important legislation. Welcome, Secretary Sebelius."

***

Health and Human Services Secretary Kathleen Sebelius:

"There has been a lot of misinformation promoted about what the Affordable Care Act will and won't do, particularly as it regards seniors and their benefits. Unfortunately, some of that has distracted from: What are the real benefits available in the new law to seniors?"

"The Affordable Care Act will finally close the prescription drug donut hole, an issue that has been a hot topic for seniors and disabled Americans. It starts this year with seniors receiving $250 checks and will gradually, over the course of the program, close the donut hole for the 8 million seniors who end up in that category right now where they are paying 100 percent out of pocket for critical prescription drugs..."

"We want to inform America's seniors what the act actually contains, what benefits they have coming their way, how to take advantage of those benefits, and what sort of priorities they will be. And this is the beginning of what will continue to be an aggressive outreach campaign."

Majority Leader Steny Hoyer:

"Older Americans faced an enormous amount of misinformation over the course of the health care debate. It was conscious, it was intended to misinform, and it was intended for political reasons, not for policy reasons."

"But now that the health insurance reform is law, the world hasn't ended, older Americans are learning about all the benefits and policies that are working to strengthen Medicare and their peace of mind."

Dr. Ben Williamowsky:

"I am here because I support the Affordable Care Act, and I believe it is important for seniors like myself to understand how the legislation will improve Medicare in the future."

"There are a lot of reasons why I believe the Affordable Care Act will be good for Medicare. And I also believe it will be good for my family, and that's a thought I would like to leave you today. People ask me, people my friends who are one of the anti-groups, who will say: 'What is it going to do for you? Why are you so much in favor of this bill?' I said: 'Well, I will tell you two very important things it is going to do for me. Number one, it is going to allow me to live out my life.

...And the other reason I give them is this, we have a granddaughter--Minna and I, Minna is in the audience--who at the age of three had a malignant brain tumor. She was operated on. She has gone through treatments all of her life. She is now 25 and functioning fairly well, but still under the care and treatment from time to time. She is 25 years old. She has been taken care of on her parents' health insurance. Now without this bill, what was going to happen when she was 26? When they could not find a job for her that has health benefits to pay that? When she could not have it any longer under her parents' insurance? She would be cut off without insurance at the age of 26 and be faced with a terrible, terrible dilemma and challenges to her going on in her life. Now I can say that she can, with this bill, that she can get health insurance and it will not be dependent on any pre-existing conditions"

Barbara Kennelly:

"So now as President of the National Committee to Preserve Social Security and Medicare, I watched this bill develop -- I read about this bill, I studied this bill. Our members -- we have 4 million members and supporters. And I went around the country telling my members and mailing to my members that this is a good idea."

"Doing nothing was not an option. Because you know why? Because we could not afford Medicare. The government couldn't afford it and the people on Medicare couldn't afford it."

"Once I tell my members what's in this bill. Once I explain to them about this bill -- they are for it. And therefore I urge all former friends of mine in the Congress: Get out there and sell this bill. Because if we don't have this bill, Medicare will be broke down the line."

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Friday, March 19, 2010

Libertarian Party opposes health care plan

The Libertarian Party adamantly opposes the health care bill passed on Christmas Eve by the US Senate that is currently being considered in the US House of Representatives. The Libertarian Party calls on the US House to vote down this disastrous plan, and instead to pass laws reducing federal involvement in health care.

Libertarian Party Chairman William Redpath commented, "We oppose this horrible federal government expansion into health care, just as we have consistently opposed all the increased government intrusion into health care proposed by Republicans and Democrats over the years. For example, we vocally opposed the huge Medicare expansion pushed through Congress by Republicans in 2003."

Redpath continued, "It is a virtual certainty that the cost estimates of this legislation are drastically understated. When Medicare Part A started in 1965, the projected cost for 1990 was $9 billion. It turned out to be $67 billion. Should this bill become law, when the debt of the United States government is downgraded by ratings agencies shortly thereafter, it will not be a coincidence. That will increase interest rates, and the entire economy will suffer."

The Libertarian Party Platform says the following about health care: "We favor restoring and reviving a free market health care system. We recognize the freedom of individuals to determine the level of health insurance they want, the level of health care they want, the care providers they want, the medicines and treatments they will use and all other aspects of their medical care, including end-of-life decisions."

The words "health care" and "medicine" are not found anywhere in the Constitution. Accordingly, the Libertarian Party asserts that Congress has no authority to regulate or appropriate money for health care. (The Libertarian Party has consistently argued for decades that the "general welfare" and "interstate commerce" clauses are not generic authorizations for spending and regulation.)

Redpath concluded, "This is a top-down, Washington-mandated control of health insurance and health care in this nation. It is the antithesis of consumer-driven health care, which is what will ultimately be necessary to control health care costs and to provide the best health care for the greatest number of people."


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Thursday, February 18, 2010

Obama Administration Grants Relief to States on Payments to Medicarefor Part D Costs

HHS Secretary Kathleen Sebelius today announced $4.3 billion in financial relief to states by reducing the amount they will have to pay the federal government to offset the cost of Medicare coverage for prescription drugs for state residents eligible for both Medicare and Medicaid.

“We believe today’s action will help states as they struggle to maintain Medicaid and other budget priorities in these difficult economic times,” said Secretary Sebelius. “This relief will help states continue to provide critical health care services to the nearly 60 million beneficiaries who depend upon it.”

This temporary financial boost to states is made possible by the American Recovery and Reinvestment Act of 2009 (ARRA). That law granted a significant, yet temporary, increase in the amount states receive from the federal government to help pay for their Medicaid programs. The increase was to the federal share of Medicaid costs, referred to as federal medical assistance percentage payments (FMAP).

In a call with state governors today, Secretary Sebelius reported that HHS will apply the ARRA increased FMAP to so-called clawback payments. The clawback payment is the amount states pay to the federal government as required by the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA). It is intended to offset some of the added expense to Medicare Part D of assuming drug costs for residents dually eligible for both programs. Prior to MMA, state Medicaid programs covered prescription drug costs for these beneficiaries. Because Medicaid is a state/federal matching program, the higher FMAP under ARRA results in a temporary reduction of the states’ share of spending and therefore in their clawback obligation.

This temporary adjustment in the clawback payments will be applied for the period October 1, 2008 through December 31, 2010. In his 2011 budget, President Obama calls for the FMAP increase established in ARRA to be extended through June 30, 2011.

“In asking Congress to extend the increased FMAP in his 2011 budget proposal, the President recognizes both the critical role Medicaid plays in the health of our most vulnerable citizens and difficulties states are experiencing given the economic downturn,” Secretary Sebelius said.

States make clawback payments monthly and CMS is currently reprogramming its billing system to calculate the new, reduced payments owed by states. The savings, which are retroactive to October 2008, will be deducted from what they otherwise would have owed going forward.

The table below shows each state’s estimated savings. Column B shows the state’s obligation under the pre-ARRA formula with column C showing the newly calculated payment, column D the total estimated savings to the state.

State (A)

Total Q1 FY 09 Thru Q1 FY 11 Clawback Based on Reg. FMAP (B)

Total Q1 FY 09 Thru Q1 FY 11 Clawback Based on ARRA FMAP (C)

Total State Savings/Fed. Cost Q1 FY 09 Thru Q1 FY 11 (D)

Alabama

$150,247,579

$106,425,199

$43,822,379

Alaska

$48,317,314

$38,286,755

$10,030,558

Arizona

$153,759,854

$108,954,983

$44,804,871

Arkansas

$87,089,886

$62,440,556

$24,649,330

California

$2,913,864,100

$2,238,430,401

$675,433,698

Colorado

$192,319,003

$150,066,687

$42,252,316

Connecticut

$296,665,054

$230,615,556

$66,049,498

Delaware

$34,099,374

$26,386,737

$7,712,637

District of Columbia

$25,602,876

$17,959,629

$7,643,248

Florida

$1,015,370,655

$732,819,868

$282,550,787

Georgia

$256,830,737

$186,189,524

$70,641,213

Hawaii

$60,409,856

$43,814,638

$16,595,218

Idaho

$46,562,615

$32,122,245

$14,440,370

Illinois

$875,508,052

$675,854,129

$199,653,923

Indiana

$209,694,287

$151,629,223

$58,065,064

Iowa

$162,359,071

$127,106,244

$35,252,826

Kansas

$113,478,227

$89,157,121

$24,321,107

Kentucky

$182,471,045

$127,408,848

$55,062,197

Louisiana

$203,392,153

$126,178,376

$77,213,777

Maine

$103,581,677

$75,744,571

$27,837,106

Maryland

$238,997,062

$187,197,783

$51,799,278

Massachusetts

$612,833,627

$480,102,616

$132,731,011

Michigan

$386,791,612

$285,445,457

$101,346,155

Minnesota

$360,083,533

$278,777,119

$81,306,414

Mississippi

$102,735,712

$65,989,013

$36,746,699

Missouri

$407,283,149

$299,443,677

$107,839,472

Montana

$28,771,325

$20,110,737

$8,660,588

Nebraska

$95,393,763

$76,664,267

$18,729,497

Nevada

$62,310,316

$45,031,768

$17,278,548

New Hampshire

$71,136,363

$56,982,733

$14,153,631

New Jersey

$696,147,055

$543,196,366

$152,950,689

New Mexico

$47,436,153

$33,768,936

$13,667,217

New York

$1,882,163,731

$1,474,399,935

$407,763,796

North Carolina

$552,941,188

$400,670,852

$152,270,335

North Dakota

$22,440,556

$18,259,530

$4,181,026

Ohio

$581,726,147

$430,246,974

$151,479,172

Oklahoma

$154,134,582

$106,156,483

$47,978,098

Oregon

$147,332,690

$108,155,974

$39,176,716

Pennsylvania

$1,000,611,930

$771,650,285

$228,961,645

Rhode Island

$97,366,309

$74,159,944

$23,206,365

South Carolina

$168,667,834

$117,154,008

$51,513,826

South Dakota

$31,593,895

$25,104,607

$6,489,288

Tennessee

$442,828,611

$321,494,820

$121,333,791

Texas

$777,317,414

$567,316,054

$210,001,360

Utah

$57,174,136

$39,826,114

$17,348,022

Vermont

$49,485,228

$36,881,632

$12,603,596

Virginia

$390,311,646

$304,575,535

$85,736,111

Washington

$359,451,673

$273,090,100

$86,361,573

West Virginia

$71,905,352

$48,544,797

$23,360,555

Wisconsin

$476,178,882

$358,970,479

$117,208,403

Wyoming

$23,393,068

$18,935,147

$4,457,921

TOTAL

$17,528,567,954

$13,215,895,031

$4,312,672,922