Category: Medicaid

Four in Ten Children are Born on Medicaid

So should we blame the moms? Bryan Caplan seems to say yes:

I’m not insisting on perfect foreknowledge, just common sense. If you insist on marriage prior to pregnancy, you screen out an awful lot of unreliable men. And there are many other excellent ways to filter out cads: Lengthen the courtship, prefer older men, wait for your man to get a steady job, avoid men with questionable family and friends, etc. Even if the marriage eventually ends in divorce, you’ve still greatly mitigated the financial harm to yourself, your kids, and taxpayers.

See his exchange with his critics at Econlog.

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Oct 11, 2011 | 4 comments | by

Health Care in Texas: The Rest of the Story

As Texas governor Rick Perry makes a splash in the Republican presidential primaries, one place where critics are looking for evidence of poor leadership is his record on health care, especially Medicaid and the uninsured. According to a recent article by Noam N. Levey in the Los Angeles Times, Texans’ access to health care is “withering” under Perry. As Levey notes, Texas has the highest rate of uninsured in the nation, over one quarter of the population. This is important, but not in the way Levey believes.

Avik Roy, of The Apothecary blog, has published a comparison of various health-related measurements in Texas and Massachusetts. Drawing upon a number of sources, Roy concludes that those who believe more government spending and regulation is good will condemn Texas’ record, but those who believe in individual choice and limited government will cheer it. But what other costs did Texans pay? Or, as Paul Krugman might frame the question: “How many children died in the street to pay for Rick Perry’s tax cuts for millionaires and billionaires?” The answer is “none.”

More importantly, Texans have decided that it’s better to create more jobs than more Medicaid dependents.

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Sep 23, 2011 | 5 comments | by

Quote of the Day

The cuts to the Medicaid program in the president’s proposal — which shifts the burden to states and ultimately onto the shoulders of seniors, people with disabilities, and low-income families who depend on the program as their lifeline — would be harmful.

Ron Pollack,
Executive Director,
Families USA

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Sep 21, 2011 | 5 comments | by

How Much Does Medicaid Pay Doctors?

Here are the numbers, courtesy of Austin Frakt:

Here are three interesting features:

  • Although Medicaid rates were 72% of Medicare’s in 2008, on the average, 11 states paid higher rates than Medicare pays.
  • New York and Rhode Island were next to last, paying close to 40% of what Medicare pays.
  • Georgia, on the other hand, pays about 90%.

Why are those last two bullets so interesting? Because, overall, New York and Rhode Island spend the most on Medicaid ($8,450 and $8,796 per enrollee) and Georgia is near the bottom ($3,892).

I’ll write more about this in the future.

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Sep 12, 2011 | 8 comments | by

Why It’s So Hard to Control Medicaid Spending

This is Avik Roy, writing at Forbes about the Medicaid program in President Obama’s home state:

Illinois has one of the most expansive Medicaid programs in the country, with annual state and federal spending of $15 billion. That compares to a state budget of $33 billion. In the Land of Lincoln, you can qualify for Medicaid if your income is under 200 percent of the federal poverty level—$44,700 for a family of four. Children qualify at 300 percent of FPL. One out of every five Illinoisans is on Medicaid, including one-third of all Illinois kids.

But in order to prove that you’re eligible for Medicaid in Illinois, all you have to do is provide a single pay stub. If that pay stub happens to be artificially low, suggesting a lower income than you actually have, it still counts as “proof” of Medicaid eligibility. As to proving Illinois residency? The nice people of Illinois merely ask that you write down your address. As a result, people earning more than the Medicaid threshold, and people who don’t even live in Illinois, are collecting Illinois Medicaid funds.

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Sep 02, 2011 | 8 comments | by

Has the Shift to Managed Care Made Medicaid Less Costly?

No. They just shift costs to providers:

The findings suggest that shifting Medicaid recipients from fee-for-service into [Medicaid managed care] did not reduce Medicaid spending in the typical state. However, the effects of the shift varied significantly across states as a function of the generosity of the state’s baseline Medicaid provider reimbursement rates. These results are consistent with recent research on managed care among the privately insured, which finds that HMOs and other forms of managed care achieve their savings largely through reduced prices rather than lower quantities.

Full NBER study here.

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Aug 05, 2011 | 4 comments | by

Rationing Care for Children in Medicaid and CHIP

Physicians experience much greater difficulty referring children in Medicaid and CHIP to specialty care, compared to privately insured children. On the basis of the physician survey, more than three times as many participating physicians—84 percent—experience difficulty referring Medicaid and CHIP children to specialty care as experience difficulty referring privately insured children—26 percent. For all children, physicians most frequently cited difficulty with specialty referrals for mental health, dermatology, and neurology.

Full GAO report here.

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Jul 08, 2011 | 5 comments | by

Federal Funding of Medicaid: Block Grant or Capped Matching Funds?

If there is anything that every free-market health economist accepts, it is that the federal formula for funding Medicaid leads to unaccountably increasing spending. Because the federal government matches state spending, states have an unavoidable incentive to spend well beyond their taxpayers’ means. As NCPA’s Pam Villarreal has concluded, this means that richer states actually get more federal Medicaid funds.

Historically, the reform preferred by free-market types is federal block grants, as most recently proposed by U.S. Senator Tom Coburn. This reform should be palatable to the other side, because it is modeled on the successful 1996 welfare reform. Unfortunately, the term “block grant” appears anathema to Democrat politicians. This may be simple guilt by association with conservative Republicans like Dr. Coburn. As a result, block grants go nowhere.

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Jul 08, 2011 | 8 comments | by

State Spending Per Medicaid Beneficiary Varies by More Than Two to One

The study, published in the July Health Affairs, shows that states in the mid-Atlantic region of the country account for the highest Medicaid spending. Per beneficiary spending in the ten highest-spending states was $1,650 above the national average, most of which ($1,186 or 72 percent) was because of the greater number of services patients received. Spending in the 10 lowest-spending states was $1,161 below the national average, with service use contributing to only $672 or 58 percent of that amount.

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Jul 07, 2011 | 7 comments | by

Does Medicaid Really Make People Happier?

This is Michael Cannon, writing at National Review Online about the Baicker/Finkelstein study summarized below:

[T]he likelihood of screening positive for depression fell from 33 percent to 25 percent, and the share reporting their health to be good or better rose from 55 percent to 68 percent. However, two-thirds of the improvement in self-reported health occurred almost immediately after enrollment, before any increases in medical consumption. The authors posit that much of this improvement could reflect “an improved overall sense of well-being” rather than “changes in objective physical health.”

Supporters of President Obama’s health-care law may tout these benefits, but the [data] does not provide the vindication they seek. First, despite being eligible for Medicaid, 13 percent of the control group had private health insurance — suggesting that on some dimension, Medicaid’s eligibility rules are already too broad.

Second, the [experiment] extended coverage to the most vulnerable population of uninsured Americans, yet the improvements in health and financial security are so far apparently modest. At higher income levels, where individuals have greater baseline access to health insurance and medical care, the benefits of expanding coverage are likely to be smaller and the costs (to the extent that crowd-out is higher at higher income levels) will be greater.

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Jul 07, 2011 | 7 comments | by
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