This essay presents Arkansas’s alternative to Medicaid expansion as a case study motivating John McDonough’s assessment of the recommendations states may want to make to the Department of Health and Human Services regarding the implementation of statewide Patient Protection and Affordable Care Act–alternative waivers scheduled to begin in 2017. Arkansas’s private option uses federal funds to purchase marketplace silver level qualified health plans for low-income, low-risk participants, while “medically frail” adults are covered through Medicaid. By improving the size and risk profile of Arkansas’s health insurance marketplace, the private option will also encourage entry of and competition among private carriers. If it succeeds in keeping insurance premiums below the level they would otherwise be in the marketplace, Arkansas’s private option could reduce subsidy costs for the federal government. Under the broadened scope of section 1332 waivers, states will be able to capture such savings and use them to support innovation across both Medicaid-funded and Treasury-subsidized programs and populations.Freely available online through the Journal of Health Politics, Policy and Law open access option.
Arkansas’s Alternative to Medicaid Expansion Raises Important Questions about How HHS Will Implement New ACA Waiver Authority in 2017July 21, 2014
A primary aim of the Patient Protection and Affordable Care Act ACA is to expand insurance coverage, especially among households with lower incomes. The Congressional Budget Office CBO projects that about one-third of the additional insurance coverage expected to occur because of the law will come from expansion of the existing, unreformed Medicaid program. The rest of the coverage expansion will come from enrolling millions of people into subsidized insurance offerings on the ACA exchanges — offerings that have strong similarities to Medicaid insurance.Unfortunately, ample evidence demonstrates that this kind of insurance model leaves the poor and lower-income households with inadequate access to health care. The networks of physicians and hospitals willing to serve large numbers of Medicaid patients have been very constrained for many years, meaning access problems will only worsen when more people enroll and begin using the same overburdened networks of clinics and physician practices.It does not have to be this way. It is possible to expand insurance coverage for the poor and lower-income households without reliance on the flawed Medicaid insurance model. Opponents of the ACA should embrace plans to replace the current law with reforms that would give the poor real choices among a variety of competing insurance offerings, including the same insurance plans that middle-class families enroll in today. Specifically, we propose a three-part plan that includes a flexible, uniform tax credit for all those who lack employer-based coverage; deregulation of Medicaid; and improved safety-net primary and preventive care.
The White House recently put out a 40-page report arguing that the 24 states that have not expanded Medicaid coverage under the Affordable Care Act ACA or “Obamacare” are hurting their poor and themselves. It’s an easy case to make, but it’s incomplete and misleading. The further truth is that Medicaid also threatens to crowd out spending for many traditional state and local functions: schools, police, roads, libraries and more.
Healthcare Reform Update: Can Medicaid beneficiaries find a doctor? The CMS wants to know | Modern HealthcareJuly 9, 2014
The CMS is planning to conduct its first nationwide research effort to answer the question of whether adult Medicaid beneficiaries can find providers, and if factors such as being in managed Medicaid versus a fee-for-service offering aid or hurt the search. What it’s likely to find, according to interviews conducted with state Medicaid officials and medical society officials in 20 states, is a mixed picture overshadowed by general concerns that reimbursement rates remain too low to entice many doctors to accept new Medicaid patients.
Many states already conduct such surveys annually, but the CMS’ aim is to standardize the collection and analysis of data from state to state. The survey will begin this fall, with the goal of reaching roughly 29,000 adult Medicaid enrollees from each state for a total sample size of approximately 1.5 million, according to a bulletin circulated to state officials.
Sebelius’s claim that Obamacare has brought ‘affordable coverage’ to 22 million people – The Washington PostJuly 2, 2014
Given that Sebelius is touting “affordable coverage,” she should stick to citing the figures for the central parts of Obamacare — insurance bought on the exchanges and the expansion of Medicaid. Those are also relatively hard numbers, whereas the figures for the young adults and off-exchange plans are much fuzzier.Since the administration actually exceeded the goal it had set for itself for exchange sign-ups, there’s really little reason to further pump up the number.Two Pinocchios
Around and after the time that the Affordable Care Act was enacted, many analysts identified problems with claims being made about the law, and we offered explanations of its likely actual effects. Too often these were brushed aside amid efforts to promote the ACA in the face of growing public opposition. But four years into the ACA, it is remarkable how well our predictions have been borne out.Below I will resurrect but five of my own specific predictions about the ACA, contrast them with what many advocates had said, and review what subsequent events have shown.
The positive case for the Indiana experiment begins with acknowledging that the ACA remains at little risk of full repeal, particularly for the next two and a half years. If one assumes that its Medicaid expansion will become increasingly entrenched, and extended, into the future, the political challenge becomes how to make somewhat privatized lemonade out of another health entitlement’s lemons. Although one might accuse some would-be conservative policy advocates as believing that healthcare reform sentences consist only of a noun, a verb and “HSA,” the Indiana plan may offer a more credible approach to improving Medicaid than thinly structured block-grant proposals alone provide.Of course, the political reality is that at least some conservative state policymakers prefer to use “Other People’s Money” via the federal Treasury rather than reallocate funds within their less open-ended state budgets. Although Indiana funded a good bit of its initial HIP experiment with an increase in its cigarette taxes on state residents, there just aren’t enough smokers there to hit more ambitious enrollment goals. The state’s hospital industry has been willing to kick in more funds through a special tax assessment, but only within the limits of getting even more revenue back in newly insured patients.
Eligibility for Assistance and Projected Changes in Coverage Under the ACA: Variation Across States : May 2014 UpdateJune 4, 2014
The authors estimate that in 2014, 56 percent of the uninsured became eligible for financial assistance with health insurance coverage through Medicaid, CHIP, or subsidized marketplace coverage. In states that expanded Medicaid eligibility, 68 percent of the uninsured became eligible for assistance, compared with only 44 percent in states that did not. Because of this difference in eligibility, the ACA is projected to reduce the number of uninsured people by 56 percent in states that expanded Medicaid, compared with only 34 percent in states that did not. The authors also provide estimates of what would happen if states that have not yet expanded Medicaid were to do so.
There were 65 million people in Medicaid by the end of April, six million more than there had been on the eve of the launch of the health law, the Obama administration said Wednesday.The success of the Affordable Care Act in growing Medicaid – a key aim of the 2010 law – is a main point of political debate. But figuring out how many actually signed up for the program for low-income Americans because of the law is complicated.
From California to Rhode Island, states are confronting new concerns that their Medicaid costs will rise as a result of the federal health care law.
That’s likely to revive the debate about how federal decisions can saddle states with unanticipated expenses.
Before President Obama’s law expanded Medicaid eligibility, millions of people who were already entitled to its safety-net coverage were not enrolled. Those same people are now signing up in unexpectedly high numbers, partly because of publicity about getting insured under the law.