House Budget Committee report on poverty released Monday by Rep. Paul Ryan (R-Wis.) focuses on welfare reform and recommends a sweeping overhaul of social programs, including Head Start and Medicaid (see pp. 103-123).
Four Pinocchios: Obama’s claim that 7 million got ‘access to health care for the first time’ because of his Medicaid expansionFebruary 24, 2014
What does this mean in terms of evaluating the president’s statement? He seems to be falling into the same trap as other Democrats, and some reporters, by assuming that everyone in the Medicaid list is getting health insurance for the first time because of the Affordable Care Act. But that number is nowhere close to 7 million. It could be as low as 1.1 million (Avalere) or as high as 2.6 million (Gaba.) If one wanted to be generous, one could include people coming out of the woodwork, even though they would have been covered under the old law, but no one is really sure what that figure is.
In any case, no matter how you slice it, it does not add up to 7 million. It is dismaying that given all of the attention to this issue, the president apparently does not realize that the administration’s data are woefully inadequate for boastful assertions of this type.
Legislation to continue Arkansas’ compromise Medicaid expansion has failed in the state House.
The plan would have reauthorized funding for the “private option” that was approved last year as an alternative to expanding Medicaid’s enrollment under the federal health law. The measure fell five votes shy of the 75 needed for passage in the 100-member House.
Under the private option, Arkansas is using federal Medicaid funds to purchase private insurance for thousands of low-income residents.
Supporters of the measure are expected to try again. House Speaker Davy Carter has said he would try multiple times if the funding measure failed.
Prior to the ACA, one key reason a number of states used Section 1115 waiver authority was to expand Medicaid coverage to low-income adults who could not otherwise be covered under federal rules. The ACA’s Medicaid expansion to nearly all low-income adults at or below 138% FPL, and the significant federal funding provided to states for this expansion, fundamentally alters the role of Section 1115 waivers in expanding coverage to adults. Through guidance and recent waiver approvals in three states, CMS has identified some of the parameters related to the use of waivers to expand coverage to adults in light of the ACA’s Medicaid expansion. This brief provides an overview of the potential role of Section 1115 waivers to expand coverage since the enactment of the ACA and key themes in recently approved and proposed coverage expansion waivers.
My suggestion that North Carolina expand insurance coverage using a Basic Health Plan under Section 1331 of the ACA could certainly have an experimental component built into it. In fact, North Carolina could seek authority to do a BHP along side a Medicaid waiver, and randomly assign those below 100% of poverty to traditional Medicaid, or the private insurance/provider option that I proposed in the BHP. The comparison would then be to determine if the private coverage option differed from traditional Medicaid in terms of outcomes.
My white paper Don Taylor NC Health Reform Proposal 1 14 14 goes beyond health insurance expansion and calls for a demonstration/test of an alternative medical malpractice and patient safety approach among those newly covered, and efforts to expand the supply of health care providers by lessening regulation and expanding the practice authority of non-physician providers are also included. We should seek comprehensive reform efforts, and not only focus on coverage expansion.
For now, nearly five million people ages 18 to 64 get no financial help to buy coverage because of the gap, according to estimates by the Kaiser Family Foundation. Many of those people are clustered in the South, living in states where income limits for Medicaid coverage have historically been among the lowest in the U.S.
Eugene Steuerle, an Urban Institute economist and former Treasury Department official who served under presidents in both parties, said he couldn’t recall a social program that excluded beneficiaries because they earn too little.
Less than half of doctors are accepting patients insured by Medicaid programs for the poor, according to a study of appointments for common specialties in 15 major U.S. cities.
Medicaid pays almost all of the cost of emergency room visits, but not as much to visit a primary care doctor. As a result, fewer doctors see Medicaid patients at least without a wait for non-urgent care, and the mostly-free ER visit is all the more attractive.As early as 1983, the Department of Health and Human Services Inspector General reported ”a very high misuse of hospital emergency rooms by Medicaid recipients.” A decade later, the IG said \”Over one-half to two-thirds of Medicaid emergency room visits are non-emergency. “In 2007, a National Center for Health Statistics report showed Medicaid doubling Emergency Room use, while people with traditional insurance and the uninsured used the ER at about the same rate. Medicaid recipients were more likely to have had multiple ER visits, and the uninsured were not. The uninsured were also no more likely to have an ER visit classified as nonurgent.The trend continues, so we can call it conclusive: Medicaid encourages people to use the emergency room more than if they were uninsured. Reality interferes with Obamacare, once again.
New study shows how Medicaid fails the poor, and why Obamacare will fail the middle class – Health – AEIJanuary 3, 2014
Medicaid patients are being relegated to third-rate clinics and long wait lines, if they can access care at all. It’s especially true when it comes to outpatient specialty care.
Obamacare follows a similar model. It promises a rich set of paper benefits, but relies on diminishing reimbursement rates to make the economics work. The narrow doctor networks found in Obamacare, and closed drug formularies, are the result of this construct. It’s a design feature of the underfunded promises that Obamacare makes, just like it has become a design feature of Medicaid. Health plans narrow provider networks to make the mandated benefits remotely affordable. In this way, Obamacare is going to inevitably fail the middle class in the same manner that Medicaid has failed the poor.
Some supporters of President Barack Obama\’s health-care overhaul say that putting uninsured Americans on Medicaid will reduce costly emergency-room visits by giving them more access to care in other settings.
But a new study found the reverse: A group of 10,000 low-income Oregon residents who recently obtained Medicaid coverage visited ERs 40% more often than those without insurance.
The new Medicaid recipients used ERs more often for all kinds of health issues, including problems that could have been treated in doctors\’ offices during business hours, according to the study published Thursday in the journal Science. Earlier studies had found the same patients used more of other medical services as well.