Tag: "Medicaid"

What Will TrumpCare Look Like?

Five people waiting in waiting roomPresident-elect Donald Trump made repealing Obamacare the cornerstone of his campaign. Now that he has won, his future administration is faced with the daunting task of unraveling nearly seven years of Obamacare.  It will not be easy. The most pressing goal should be to replace all the costly provisions in Obamacare with the consumer-friendly health plans most Americans prefer. In the process, reformers must change the way medical care is financed so that consumers have control over their health care dollars as well as the means to pay for medical care over their lifetimes.

Should Medicaid Pay Family Members to Care for Disabled Patients?

care-home_2063592bWe now take a break from discussion of the Trump transition (to which we will surely return), to bring up a very delicate subject: How to ensure severely disabled patients do not become victims.

What politician could ignore the pleas of families caring for disabled members, asking for some help with the burden they carry? Unfortunately, government funding this type of personal care cannot deter significant unintended consequences.

The Office of Management and Budget (OMB) has designated 16 programs as “high error” which means money goes offside due to fraud, waste, and abuse. Medicaid, the joint state-federal program that subsidizes medical services for low-income people, ranks highly on the list. $29.1 billion, or almost ten percent of the $297.7 billion federal contribution is considered by the U.S. government to be paid “improperly.”

The Department of Justice under President Obama has had significant success tracking down and charging those who bill Medicaid and Medicare falsely. However, there is an even worse type of abuse happening in Medicaid: Actual physical abuse of the most vulnerable patients in the system. This often goes hand-in-hand with financial fraud in the area of personal-care services.

Medicaid Expansion Also Expands ER Use

A new report in the New England Journal of Medicine found that Medicaid expansion in Oregon actually increased use of the emergency room (ER) by people newly covered by Medicaid. Policy experts had expected ER use to fall as people gained coverage and could have a usual source of care, such as a primary care physician.  Within the first 15 months after gaining coverage, ER use spiked by about 40%, and remained high for subsequent years. It did not appear the people using the emergency room were necessarily substituting ER visits for primary care physicians (PCP) visits. Rather, PCP visits and ER visits appeared to be complementary.

Mercatus senior research fellow Brian Blase covers the implications in much more detail at Forbes. Blase points out that the value of Medicaid benefits is less than the cost, enrollees are misusing their benefits (ER visits when primary care would suffice). ER overuse makes it harder for those truly in need of emergency care to be seen in a timely manner. It is also arguably why the cost of  Medicaid expansion is far above initial projections.

 

More Than One In Five Americans “Churn” Through Health Coverage Within A Year

Census2The U.S. Census Bureau has just released the Current Population Report’s Health Insurance Coverage in The United States, 2015. This report sits alongside the Centers for Disease Control and Prevention’s National Health Interview Survey as a critical source of understanding changes in health insurance in recent years.

The report discusses coverage during the three years from 2013 through 2015, so it does not reveal the large increase in employer-based coverage since the great recession. During this shorter period, there was an insignificant gain in employer-based coverage, and a large increase in persons dependent on Medicaid, the joint state-federal welfare program that provides health benefits to low-income residents. The number of people dependent on Medicaid for at least part of the year increased from 55 million in 2013 to 62 million in 2015. (Almost the entire increase took place in 2014, Obamacare’s first year of implementation.)

Arkansas’ “Private” Medicaid Expansion Improved Access to Care (At A Very High Price)

doctor-mom-and-sonArkansas has a love-hate relationship with Obamacare. The previous (Democratic) governor, Mike Beebe, made a deal to accept Obamacare’s Medicaid expansion but with an interesting twist. Obamacare significantly increased the number of Americans who could become dependent on Medicaid by increasing the income cut-off for eligibility. Many governors rejected the federal funds offered to expand this welfare dependency.

Governor Beebe took the money, but instead of using it to expand Medicaid for the newly eligible, he used it to subsidize beneficiaries’ purchase of private plans in Obamacare’s health insurance exchange. His successor, Republican Asa Hutchinson, and the Republican-majority legislature, decided to continue the program.

According to new research published by the University of Pennsylvania, this “private option” yielded dramatically improved access to care. In a “secret shopper” survey, callers identifying themselves as dependents on traditional Medicaid were able to make appointments with primary-care physicians in 55.5 percent of attempts. Medicaid dependents enrolled in exchange plans got appointments 83.2 percent of the time.

Obamacare Slightly Increased Short-Term Uninsured

NHISThe best measurement of people who lack health insurance, the National Health Interview Survey published by the Centers for Disease Control and Prevention (CDC), has released early estimates of health insurance for all fifty states and the District of Columbia in 2015. There are two things to note.

Health Status Related to Income Not Insurance

Women joggingAn extremely thorough analysis of changes in incomes and mortality in the United States, 2001 through 2014 presents some sobering conclusions for those who think fixing our health system will make us healthier. The research, let by Raj Chetty of Stanford University, ran data on incomes and mortality through a battery of statistical tools.

It is well understood that people in high-income households are healthier than those in low-income households. The latest research demonstrates how important incomes are to health status. Forty-year old men in households in the highest quartile of income (mean = $256,000 annually) had an average life expectancy just under 85 years in 2001. This increased by 0.20 years (a little over ten weeks) by 2014. For those in the lowest quartile ($17,000), life expectancy was about 76 years in 2001, and it only increased 0.08 years (a little over four weeks) by 2014.

Obamacare is likely to accelerate this gap, because it significantly reduces incentives for people in low-income households to increase their incomes.

CBO: Obamacare’s Uninsured Up 5 Million, Medicaid Dependents Up 16 Million Since Initial Estimate

half full or half empty?

(A version of this Health Alert was published by Forbes.)

Last week’s Congressional Budget Office’s Updated Budget Projections: 2016 to 2026 significantly reduced estimates of Obamacare’s benefits, relative to CBO’s estimates published in 2010, when the law was signed:

  • In 2010, CBO estimated Obamacare would leave 22 million uninsured in 2016 through 2019. This month, CBO estimates Obamacare will leave 27 million uninsured through 2019 – an increase of almost one quarter.
  • In 2010, CBO estimated Obamacare would leave 163 million with employer-based health benefits in 2016 and 159 million in 2019. This month, CBO estimates Obamacare will leave only 155 million with employer-based plans. The number will decrease to 152 million in 2019.
  • In 2010, CBO estimated Obamacare exchanges would enroll 21 million people in 2016, increasing to 24 million in 2019. This month, CBO estimates Obamacare’s exchanges will enroll only 13 million people this year, and 20 million in 2019.
  • In 2010, CBO estimated Obamacare would result in 52 million Americans remaining or falling into dependency on Medicaid or the Children’s Health Insurance Program, the welfare programs jointly funded by state and federal governments that subsidizes low-income households’ health care, in 2016. CBO estimated that figure would drop slightly to 51 million in 2019. This month, CBO estimates 68 million will be dependent on the program this year through 2019 – an increase of almost one third in the welfare caseload.

Ever Increasing Tax Hikes Won’t Save Medicaid

Ambulance at Emergency Entrance(A version of this Health Alert was published by the Orange County Register.)

After more than a year, California’s politicians and health insurers have finally agreed to and passed last month what California Healthline calls a “tax hike in name only” to finance Medi-Cal, California’s Medicaid program. If only it were that simple.

Funded jointly by the state and federal governments, Medicaid is the subject of perverse political incentives to hike taxes and spend more money on this welfare program, impoverishing treasuries. California and the nation need a new way to finance Medicaid.

Increasing Medicaid Dependency Does Not Reduce “Uncompensated” Care

iStock_000007047153XSmallRobert Laszewski is a leading health insurance expert whom I often cite favorably. However, in a recent article praising Ohio governor John Kasich he has made an unforced error. Governor Kasich is one of only three Republican governors who took federal Obamacare money to expand Medicaid dependency. According to Mr. Laszewski:

On Medicaid, the Kasich administration helped 650,000 people whose uncovered health-care costs were being shifted onto and burdening employers and individuals struggling to pay their already-high health insurance costs. The administration enrolled them into a new Ohio Medicaid system that made 38 different reforms over five years. In 2015 alone, it saved Ohio taxpayers $1.9 billion compared with the original state-budget target. It held the program’s per capita cost growth below 3 percent while cutting the state’s uninsured rate in half.

The idea that people who cannot pay their hospitals bills are the major problem in driving American health costs is evidence-free. According to a September 2014 report promoting Obamacare’s benefits, Obamacare’s reduced so-called “uncompensated care” by $5.7 billion in 2014. Health spending in 2014 was $3 trillion, so $5.7 billion is less than one fifth of one percent of national health spending!