In 2014 twenty-eight states and the District of Columbia had expanded Medicaid eligibility while federal and state-based Marketplaces in every state made subsidized private health insurance available to qualified individuals. As a result, about seventeen million previously uninsured Americans gained health insurance in 2014. Many policy makers had predicted that Medicaid expansion would lead to greatly increased use of hospital emergency departments (EDs). We examined the effect of insurance expansion on ED use in 478 hospitals in 36 states during the first year of expansion (2014). In difference-in-differences analyses, Medicaid expansion increased Medicaid-paid ED visits in those states by 27.1 percent, decreased uninsured visits by 31.4 percent, and decreased privately insured visits by 6.7 percent during the first year of expansion compared to nonexpansion states. Overall, however, total ED visits grew by less than 3 percent in 2014 compared to 2012–13, with no significant difference between expansion and nonexpansion states. Thus, the expansion of Medicaid coverage strongly affected payer mix but did not significantly affect overall ED use, even though more people gained insurance coverage in expansion states than in nonexpansion states. This suggests that expanding Medicaid did not significantly increase or decrease overall ED visit volume.
Medicaid Expansion In 2014 Did Not Increase Emergency Department Use But Did Change Insurance Payer MixAugust 17, 2016
The Healthy Indiana Plan 2.0 is now just over a year old. It’s Indiana’s version of the expanded Medicaid program offered by the Affordable Care Act. But unlike traditional Medicaid, Indiana received waiver approval for an alternate system that incorporates personal responsibility and consumer-driven health care. Here’s the theory: if one is financially engaged, it encourages a sense of ownership, personal empowerment, and responsible utilization of medical services.
Every state except Alaska (and Alaska recently awarded a contract to a firm “to study and develop” a tax proposal) uses Medicaid provider taxes. Since provider taxes are essentially a kick-back, the providers who benefit the most are generally those serving a larger number of Medicaid enrollees. They receive higher Medicaid payments than they would have received in the absence of the tax.
The kick-back often involves extra payments, dubbed supplemental payments, to providers. These extra payments raise serious questions of political influence and cronyism. For example, in 2014 GAO identified two New York City hospitals—Coler Memorial and Coler Goldwater— that received $416 million in extra Medicaid payments in 2011 in addition to $70 million in regular Medicaid payments. These Medicaid payments were nearly five times what Medicare would have paid these hospitals for these services, which is supposed to be the legal limit on what Medicaid can pay.
Cancer patients insured by California’s health plan for low-income people are less likely to get recommended treatment and also have lower survival rates than patients with other types of insurance, according to a new study by University of California-Davis researchers.
While other studies have linked Medicaid insurance status to worse cancer outcomes, the UC-Davis study appears to be the first to examine the impact of various kinds of health insurance across more than one kind of cancer.
That even a slim majority of Republicans favor expansion is notable given the tone of debate on this issue on the campaign trail, where expansion has become like a third rail for GOP candidates. This is not to suggest that Republican candidates or governors who oppose Medicaid expansion in conservative states will be anxious to flip any time soon. But Medicaid may not be as unpopular with Republicans overall as the conventional wisdom suggests, and other issues may be more salient for Republican voters in primary and general elections across the country than opposition to Medicaid expansion.
Health insurance enrollment data for 2014 shows that the number of Americans with health insurance increased by 9.25 million during the year. However, the vast majority of the increase was the result of 8.99 million individuals being added to the Medicaid rolls. While enrollment in private individual-market plans increased by almost 4.79 million, most of that gain was offset by a reduction of 4.53 million in the number of people with employment-based group coverage. Thus, the net increase in private health insurance in 2014 was just 260,000 people.
Wake Forest University’s Health Law and Policy Program will be releasing a report: “Medicaid Reform Options for North Carolina | Bioethics at WFUMay 5, 2015
“Medicaid Reform Options for North Carolina
POSTED ON THURSDAY, APRIL 30, 2015, 11:16 AM | BACK TO NEWS & ANNOUNCEMENTS
Edwin Shoaf, Health Law and Policy Research Associate and Mark A. Hall, Professor of Law & Public Health, both of Wake Forest University’s School of Law released this report 4/30.