Category: Medicaid

Best Analysis of the Oregon Medicaid Experiment I Have Seen

In summary, based on statistically insignificant effects of coverage from the Oregon Experiment: (1) The effects that are closest to statistical significance are that coverage would increase the rate of smoking and damage the cardiovascular prognosis of sick people; (2) the best estimated net effect on total population cardiovascular health is extraordinarily tiny; (3) this effect would be achieved by making the sick sicker, while very slightly improving the health of already healthy people; and (4) this effect is almost certainly unattractive on a risk-adjusted basis. This is not a series of effects that makes a very attractive argument for an increase in health from the experiment.

This is Jim Manzi via Megan McArdle. Entire piece is fascinating.

Print FriendlyPrint

May 15, 2013 | 8 comments | by

One More Reason to Not Like Medicaid

Researchers at George Washington University looked at Medicaid “churn” — when beneficiaries move on and off the rolls because of small variations in income — and found that it leads to more hospitalizations and higher costs for patients. According to the study, a Medicaid beneficiary enrolled consistently for 12 months pays $333 in medical bills per month, on average. Patients enrolled for six months paid $469, and those enrolled for one month paid $625.

See more at The Hill.

Print FriendlyPrint

May 14, 2013 | 14 comments | by

You Can Lead a Horse to Water…

I want to make just one observation based on Avik Roy’s outstanding write-up of the Oregon Medicaid project.

Most of the commentary has been shocked that there was no statistically significant improvement in health measures between people who were enrolled in Medicaid and those who were not.

I want to focus on a different issue, one that I have been hammering on in these pages ― that ObamaCare is unlikely to increase the number of people with insurance.

Before we even get to the outcomes question is the issue of whether very many people want to have insurance coverage, even when it is totally free.

Print FriendlyPrint

May 02, 2013 | 18 comments | by

The American Health Line Quote of the Day

“A lot of people are way too focused on health insurance and not focused enough on health care.”

John Goodman, president and CEO of the National Center for Policy Analysis, on a report that found Medicaid does not significantly improve health

I’ll have more to say about this in the future.

Print FriendlyPrint

May 02, 2013 | 13 comments | by

Reaction to the Oregon Medicaid Study

The latest results, showing that Medicaid makes you happier, but not healthier, provoked this:

Ray Fisman in Slate:

It’s time for liberal media types like myself to eat some humble pie.

Avik Roy:

The result calls into question the $450 billion a year we spend on Medicaid, and the fact that ObamaCare throws 11 million more Americans into this broken program.

James Pethokoukis (AEI):

The researchers running the study are talking up those positive results, but that is just a lame effort to turn lemons into lemonade

Michael Cannon (Cato):

There is no way to spin these results as anything but a rebuke to those who are pushing states to expand Medicaid.

Zeke Emanuel: “It’s disappointing.”

Megan McArdle: “Shocker.”

When Katherine Baicker described the preliminary finding that Medicaid enrollees “felt healthier” two years ago at a Cato forum, she was almost giddy. There was no giddiness this week. The researchers appeared almost desperate to find something good to say. Tyler Cowen writes:

Reading more carefully through the quotations from [Amy] Finkelstein and [John] Holahan in the [New York Times], I find it amazing, and I suppose even embarrassing, what those commentators are claiming as a positive result.

Print FriendlyPrint

May 02, 2013 | 17 comments | by

BREAKING: Stunning Results: Medicaid Does Not Improve Physical Health

In 2008 Oregon expanded its Medicaid program on a limited basis to 30,000 people who were selected through a lottery system out of 90,000 who wanted to enroll. A preliminary analysis found that Medicaid coverage improved access to care and perceived wellbeing for those selectively enrolled. But it was too early to assess the impact on health. Now, a new follow-up report in the New England Journal of Medicine reveals a stunning finding: the program apparently is having no effect on physical health!

Those selected to enroll increased their use of medical care. For example, new Medicaid enrollees were more likely to be diagnosed for diabetes and to take diabetes medication. However, this did not result in better control for their diabetes. Moreover, researchers also found Medicaid did not improve detection or control of high blood pressure or high cholesterol:

Medicaid coverage did not have a significant effect on measures of blood pressure, cholesterol, or glycated hemoglobin. Further analyses involving …those who reported receiving a diagnosis of diabetes, hypertension, a high cholesterol level, a heart attack, or congestive heart failure before the lottery … showed similar results…

Print FriendlyPrint

May 01, 2013 | 18 comments | by

Outlook for Medicaid Expansion

Sarah Kliff reposts this map by Caroline Pearson of Avalere Health:

Medicaid Eligibility

She adds this:

The decisions that states make this year aren’t binding; a state can decide to participate in the Medicaid expansion at any time. When Medicaid first launched, it took over two decades to convince all 50 states to participate. Eventually, federal dollars lured reluctant states like Arizona into the fold. We’re about to see whether Obamacare dollars can do the same.

Print FriendlyPrint

Apr 29, 2013 | 10 comments | by

Florida Looks at an Alternative to Medicaid Expansion

Under the new Florida House proposal, parents below the poverty line who didn’t already qualify for Medicaid would get $2,000 a year deposited into a health savings account called a CARE account (CARE stands for “Contribution Amount for Reasonable Expenditures”) in exchange for an individual contribution of $25 a month, for a total HSA contribution of $2,300 per year. The proposal would also offer this benefit to disabled individuals below the poverty line who are ineligible for Medicaid.

Beneficiaries could use their CARE accounts to purchase whatever health coverage products they want, through a health-insurance clearinghouse called Florida Health Choices. Unlike ObamaCare’s subsidized insurance exchanges, which force insurers to adhere to a bevy of mandates and regulations in order to participate, the Florida insurance clearinghouse allows insurers to sell a broad range of insurance products, including catastrophic coverage.

Alternatively, a CARE beneficiary could keep the $2,300 in the health savings account and use that money to pay for out-of-pocket expenses. Any unused expenditures would roll over into the following year.

More from Avik Roy.

Print FriendlyPrint

Apr 17, 2013 | 15 comments | by

State Alternatives to Medicaid Expansion

States are being encouraged to take the federal money and run — headlong into expanding their Medicaid program. However, this federal gravy train cannot go on forever. In a paper commissioned by the Galen Institute, Chris Jacobs explains that states have other options when reforming health care within their states:

  • Rhode Island got a waiver granting it the flexibility to use home and community-based services as an alternative to nursing homes.
  • Indiana developed a program similar to consumer-driven health plans to provide coverage and the appropriate incentives to low-income populations.
  • Florida successfully tested private managed care plans as a way to cover low-income families.

Print FriendlyPrint

Apr 11, 2013 | 13 comments | by

Should Arkansas Accept the ObamaCare Medicaid Deal?

The Deal: Arkansas would be allowed to send its Medicaid enrollees to the (private insurance) exchange.

Avik Roy summarizes the case for doing that:

There are a lot of reasons why Medicaid provides low-quality coverage with poor access to physicians and enormous amounts of waste, fraud, and abuse. One of the biggest is that Medicaid requires almost nothing of its enrollees in terms of cost-sharing: co-pays, deductibles, and the like. Because Medicaid patients have no financial incentive to avoid wasteful consumption of medical services, they often over-use the emergency room — where the co-pay is usually less than $5 — and other costly facilities.

In addition, “any willing provider” rules prevent the government, or even private insurers managing Medicaid patients, from organizing their provider networks to steer these patients to hospitals and doctors who provide cost-efficient care.

By contrast, insurers on the exchanges can compete on just this basis: by tiering co-pays so as to steer patients to higher-quality, lower-cost doctors and hospitals. By charging higher fees for non-urgent use of the emergency room, and higher co-pays for using branded drugs where cheaper generic ones will work just as well. These are all things that Medicaid, as it’s currently designed, can’t do, even if the Medicaid “benefit” is managed by private insurers, as it already is with two-thirds of Medicaid enrollees.

The Fine Print: For Medicaid enrollees the exchange will be a faux exchange. No additional cost sharing will be allowed. No tiering. Any willing provider rules remain in force.

So, while carriers on the faux-exchanges will be pitted against each other in a thing that some will call “competition,” there will be little room for plans to actually compete with one another.

Print FriendlyPrint

Apr 08, 2013 | 13 comments | by
Next Page »