Fix Medicaid’s Perverse Funding Formula | American Commitment

December 18, 2014

One of the most perverse consequences of the feverish backroom deals used to get Obamacare past the finish line was the funding formula for the law’s Medicaid expansion, which started with the infamous Cornhusker Kickback, a sweetheart deal for Nebraska alone to get 100 percent federal funding for Medicaid expansion that was used to get then-Senator Ben Nelson’s vote.

When the whistle was blown on that dirty deal, Nelson implausibly explained that the Nebraska-only provision was intended to be a “placeholder” for higher Medicaid funding for all 50 states.  And that’s what ended up ultimately passing: if a state expands Medicaid to able-bodied adults, the new population is eligible for 100 percent federal funding through 2016, phasing down starting in 2017 until it reaches 90 percent in 2020 and permanently thereafter.

Yet states continue to receive an average of 57 percent federal funding for the pre-expansion Medicaid population of needy families and people with disabilities.  In short, under current law, states are given a huge financial incentive to favor able-bodied adults over the truly needy.  It’s shameful and it should be fixed.

via Fix Medicaid’s Perverse Funding Formula | American Commitment.


‘Healthy Utah’ Obamacare Expansion: Worse Than Expected

December 7, 2014

Gov. Herbert has consistently said that he is “trying to make lemonade” out of Obamacare lemons by crafting a “Utah-specific” plan. Rather than making lemonade, the Governor appears to have been drinking the Obamacare Kool-Aid. The “Utah-specific” plan is nothing more than old policy failures copied-and-pasted from other states.

Herbert’s “Utah-specific” idea of using health plans sold on the Obamacare exchange to provide this new entitlement class with Medicaid benefits is copied from Arkansas and Iowa, where the policy has been a failure. In Arkansas, costs have run over budget every single month and state lawmakers are poised to repeal the plan. In Iowa, state bureaucrats have already asked for more money from Washington and had to move thousands of adults out of the waiver and into traditional Medicaid after half of the participating insurers hiked premiums 20 percent and dropped out of the plan.

His other “Utah-specific” ideas were also recycled from these failed experiments: the idea to impose nominal, non-enforceable “premiums?” Taken from Iowa and Pennsylvania. The idea to have a completely voluntary work assistance program? Taken from Pennsylvania and Indiana. If Utah lawmakers were hoping for a “Utah-specific” plan, they’re sure to be disappointed.
via ‘Healthy Utah’ Obamacare Expansion: Worse Than Expected.


To Extend or Not to Extend the Primary Care “Fee Bump” in Medicaid?

December 5, 2014

Policy makers and researchers are eager to learn the effects of the Patient Protection and Affordable Care Act of 2010 (ACA) and its many provisions, but to date, they have been frustrated by the dearth of robust evidence on the ACA’s true impacts on important health care and patient outcomes (e.g., access to primary care services). The present limitations of evidence, often a consequence of delays and inconsistencies in the law’s implementation, have begun to affect policy making in the ACA’s wake.

In this article, we consider the ongoing debates among state and federal policy makers aboutwhether to extend the ACA’s so-called fee bump provision, whereby Medicaid fees for primary care services were increased to 100 percent of Medicare levels during 2013 and 2014. We describe the difficulties state Medicaid programs have experienced in implementing the fee bump as well as how the resulting evidence gap and the broader political context today shape the deliberations. To conclude, we identify policy alternatives and other factors policy makers should consider when deciding whether to extend the fee bump.

To Extend or Not to Extend the Primary Care “Fee Bump” in Medicaid?.


Wyoming Devises Plan to Expand Medicaid – NYTimes.com

November 28, 2014

With a plan released Wednesday by the administration of Gov. Matt Mead, a Republican, Wyoming has become the latest state seeking to expand Medicaid.

The plan would provide Medicaid coverage to an additional 18,000 low-income people, according to the state’s health department. If it wins federal and state legislative approval, Wyoming will join 27 states that have expanded the program under the Affordable Care Act, including nine with Republican leadership.

As several other Republican governors have done, Mr. Mead wants to require some people who receive coverage under the expansion to pay something toward the cost. Under his plan, those earning 100 to 138 percent of the federal poverty level — for a single person, $11,670 to $16,105 a year — would have to pay monthly premiums. The premiums could range from about $20 to $50 a month, depending on household size and income, according to a summary of the plan.

via Wyoming Devises Plan to Expand Medicaid – NYTimes.com.


Will Gov Herbert Engage In Obamacare Debate Or Stick With Name Calling?

November 24, 2014

We have expressed our disappointment in Gov. Gary Herbert (R-UT) for his decision to pursue expanding Obamacare in Utah. Herbert has spent months negotiating an Obamacare expansion plan with the federal government, despite the lack of legal authority to commit the state to any “deal” he strikes with the Obama administration. His drive to expand is seemingly out of character, as he has been solid in the past expressing concerns about the insidious federal strings that come with Obamacare.

via Will Gov Herbert Engage In Obamacare Debate Or Stick With Name Calling?.


Prospects to expand Medicaid services in NC dim for 2015 | State Politics | NewsObserver.com

November 19, 2014

Any plan Gov. Pat McCrory’s administration presents for expanding Medicaid would have a tough time getting through the state legislature.

A key House member said Tuesday it would probably be premature to consider expanding Medicaid next year with the future of the federal health care law uncertain.

The Republican-controlled Congress is expected to make changes to the Affordable Care Act, under which states had the option to make more people eligible for the government health insurance program. The U.S. Supreme Court will hear a case about who is eligible for tax credits under the law.

Rep. Nelson Dollar, a Cary Republican and a legislator who works extensively on Medicaid policies, said state should wait “until we see what fully develops” in Congress and with the court case. The state then “would have a better idea of what the lay of the land is,” he said.

via Prospects to expand Medicaid services in NC dim for 2015 | State Politics | NewsObserver.com.


Hospital CEO Contends With Medicaid Conundrum – WSJ – WSJ

November 12, 2014

Underlying the hospitals’ financial problems, Mr. Shields said, is a systemic dilemma shown in a graph he has been displaying to policy makers and business leaders. It highlights the gap between Truman’s cost of caring for people without insurance and government funding the hospital gets to cover it—nearly $30 million in fiscal 2014, according to Truman. One of his slides notes that Truman currently has just one day of cash on hand. The gap is “not sustainable over time,” Mr. Shields said.

The health law could exacerbate the problem. Under the measure, federal payments to hospitals like Truman that provide a lot of unpaid care are supposed to be cut substantially, though Congress delayed the timing until 2017. Truman projects its reduction could amount to $22 million in 2017, growing to $34 million in 2018.

via Hospital CEO Contends With Medicaid Conundrum – WSJ – WSJ.


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