who have rejected ObamaCare’s misguided Medicaid expansion completely misses the mark. He contends that Arkansas’ “Private Option” is really just a block grant for Medicaid. But the truth lies in the fine print, and while there is no question the Private Option puts state taxpayers at risk, it also creates a new entitlement and ceded most of the control for the program to the federal government. It’s like putting the fox in charge of the hen house.
Is Arkansas’ “Private Option” A Block Grant? Insurance Expert Bob Laszewski Thinks So, But He Is WrongApril 17, 2014
Medicaid, originally considered an afterthought to Medicare, is today the largest health insurance provider in the United States. Under the Affordable Care Act, the Congressional Budget Office projects Medicaid enrollment to increase nearly 30 percent by 2024, and federal spending on the program to double over the next decade. For the states, Medicaid is already the largest single budget item, and its rapid growth threatens to further crowd out other spending priorities.
In this collection of essays, nine experts discuss the escalating costs and consequences of a program that provides second-class health care at first-class costs. The authors begin with an explanation of Medicaid’s complex federal-state funding structure. Next, they examine how the system’s conflicting incentives discourage both cost savings and efficient care.
The final chapters address the pros and cons of the most mainstream Medicaid reform proposals and offer alternative solutions. This book offers a timely assessment of how Medicaid works, its most problematic components, and how — or if — its current structure can be adequately reformed to provide quality care, at sustainable costs, for those in need.
Key points in this Outlook:
Under the Affordable Care Act (ACA), states have been given the authority to decide whether to expand eligibility to their Medicaid programs to cover anyone below the eligibility threshold for ACA subsidies.
Medicaid spending, already a large state expenditure, will increase dramatically—perhaps by as much as 12 percent in 2014—if states choose to expand their programs.
The federal government should change the Medicaid program to allow more state-level reform and innovation that will both improve budget efficiency and protect vulnerable populations.
Since last October, more than three million U.S. residents have enrolled in Medicaid or the Children’s Health Insurance Program through the Affordable Care Act, according to preliminary data released Friday by the Obama administration, the New York Times reports.
For the report, the administration compared Medicaid and CHIP enrollment figures for February 2014 against the average monthly enrollment data from July through September 2013, just before the ACA’s insurance exchanges launched (Pear, New York Times, 4/4).
Fewer than half of states offer dental care to adult Medicaid enrollees | State Health Access Data Assistance CenterMarch 29, 2014
Fewer than half of all U.S. states offer dental care to Medicaid eligible non-elderly adults according to a study by SHADAC’s Kathleen Call and Jessie Kemmick-Pintor along with Nafisa Elmi and Pricilla Flynn of the University of Minnesota’s School of Dentistry. Even among adults living in states that offer dental benefits through Medicaid, such coverage does not ensure they will seek or access dental care.
The study authors project the effect of the ACA on patient-identified barriers to dental care based on a framework developed using data from a 2008 survey of Minnesota Medicaid enrollees with and without an annual dental visit. They project that the ACA will not reduce barriers to dental care for adult Medicaid enrollees.
Maine staved off a fiscally disastrous Medicaid expansion recently this week with a slim margin in the legislature. Though the bill to expand the program passed the Maine House of Representatives, it garnered only 97 votes; one less than the required two-thirds majority needed to override Governor LePage’s veto. It seems the Governor is the final levy against increased dependency rates in Maine, but Republican defections could soon allow Democrats to bypass the veto.
Democrats also failed to gain the two votes needed for a super majority in the Senate.
To make matters worse for state Democrats, a recent poll showed that the more Maine taxpayers find out about Medicaid expansion, the more they oppose it.
I had the experience of dealing with Medi-Cal (California’s name for its’ Medicaid plan) in the early 90s when I had started a primary care solo practice. Of 40 primary care docs in a 3 mile radius of my office, I was one of three who accepted Medi-Cal.
The payment for any office visit was so low that it bordered on punitive. The state paid approx 1/3 of the average commercial rate at that time and actually decreased the rate and payment over the past 20 years. California, perhaps not unique compared to all states, also had a nasty habit of stopping payment for any Medi-Cal billed services when the budget for that year ran out, even if that was after 7-8 months. Practices that absolutely depended on Medi-Cal reimbursement went unpaid until the start of the next fiscal year, at which time the backdue payments would trickle in until the next stoppage.
But the most important benefit of the program, corrections officials say, is that inmates who are enrolled in Medicaid while in jail or prison can have coverage after they get out. People coming out of jail or prison have disproportionately high rates of chronic diseases, especially mental illness and addictive disorders. Few, however, have insurance, and many would qualify for Medicaid under the income test for the program — 138 percent of the poverty line — in the 25 states that have elected to expand their programs.
Health care experts estimate that up to 35 percent of those newly eligible for Medicaid under Mr. Obama’s health care law are people with histories of criminal justice system involvement, including jail and prison inmates and those on parole or probation.
While only half the states have expanded Medicaid to new populations, every state operates a Medicaid program. That is a critical difference between exchanges, which opened for business last October, and Medicaid, which has been around for 50 years. People are determined eligible for Medicaid every day in every state – seniors, people with developmental disabilities, pregnant women, children under 18, low-income parents – and there is no way to infer from government reports which people added to the Medicaid rolls are newly eligible thanks to Obamacare and which would have been eligible even if Obamacare had never become law.
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).