Tag: "Medicaid"

Commonwealth Fund: “Underinsurance” Unchanged Under Obamacare

Yet another pro-Obamacare organization has had to publish a study indicating that Obamacare is failing to achieve its objectives. I recently discussed Families USA’s report that one third of low income families cannot afford care under Obamacare.

This time it is the Commonwealth Fund, inventor of the notion of “underinsurance,” which is defined as out-of-pocket health costs (excluding premiums) comprising at least 10 percent of household income, or five percent if household income is less than 200 percent of the Federal Poverty Level.

In 2014, the proportion of so-called “uninsured”, aged 18-64, was 23 percent – exactly the same as in 2012 and just one percentage point more than in 2010.

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Families USA: One Third of Low-Income Obamacare Beneficiaries Cannot Afford Care

One of Obamacare’s biggest cheerleaders, Families USA, has published new research showing that one third of low-income Obamacare beneficiaries have not obtained medical care due to cost in 2014:

Lower- to middle-income adults who were insured for the full year were significantly more likely than those with higher incomes to forgo needed care because they could not afford it: Nearly one-third (32.3 percent) of lower- to middle-income adults didn’t get needed medical care (excluding dental care) because they could not afford it. (p. 14)

But don’t you worry, Families USA has not thrown in the towel on Obamacare yet:

Since its passage in 2010, the Affordable Care Act (ACA) has made tremendous progress in improving access to health insurance and health care for millions of Americans. Approximately 14.1 million previously uninsured Americans gained health insurance between the beginning of open enrollment in October 2013 and March 4, 2015.

Well, not actually: Most of the Obamacare “insured” have actually fallen into welfare dependency (Medicaid), and the increase in privately insured is questionable.

Families USA recommends that even more taxpayer-funded healthcare dollars be channeled through health insurers. Investors in health insurers must love these policy prescriptions from progressive advocacy groups.

Washington, DC: Rich World’s Worst Capital for Infant Mortality

Save the Children has a new report ranking 25 of the world’s richest capital cities by childhood mortality. Washington, DC is the worst. Prague, Stockholm, Oslo, Tokyo, and Lisbon lead.

But I think the international ranking was just to get headlines. The real point of the report is to emphasize differences in infant mortality between rich neighborhoods and poor neighborhoods in these rich capitals:

  • In examining infant deaths in D.C., Save the Children found that in 2012 the infant mortality rate in DC’s poorest neighborhood (Ward 8) was more than 10 times higher than the rate in DC’s wealthiest community (Ward 3).

  • In 2012 the infant mortality rate in ward 8 was 14.9 deaths per 1,000 live births. In contrast in Ward 3, the city’s wealthiest ward, the rate was 1.2 deaths per 1,000 live births.

I suppose that many will use this report to call for increases in Medicaid spending, which has increased relentlessly over the years without eliminating this difference.

 

House & Senate Agree on Balanced Budget Resolution

The House and Senate Budget Committees have announced that their conference committee has agreed on a balanced budget resolution. The conference report is 106 pages, so it will take me a few days to complete an analysis.

Nevertheless, it is important to recognize that this is an important achievement and the result of a lot of hard work by Dr. Price, Senator Enzi, their colleagues and staff. For many years, the Senate ignored its legal obligation to pass a budget.

With respect to health care, the resolution repeals and replaces Obamacare in full. It also continues to increase Medicare premiums for high-income households, and transitions to Paul Ryan’s “premium support” model for future beneficiaries.

One of the items I had been hoping for is offsets to pay for the bungled Medicare “doc fix” of last month. The resolution states that it accounts for the full cost of that “doc fix” (page 45). Okay, but the current president will not sign this budget. Are we meant to expect that the next President will take responsibility for the unfunded spending authority this Congress gave President Obama?

Banned from Medicare; Still Billing Medicaid

Yahoo! News has a special report about physicians who have been banned from billing Medicare or some state Medicaid programs because of fraud, but are still billing other states’ Medicaid programs:

 A doctor who took kickbacks from a Pennsylvania hospice involved in a multimillion-dollar fraud. An Ohio psychiatrist who billed for treating no-show patients. A Georgia optometrist who claimed he conducted 177 eye exams in one day.

Their transgressions vary. What these doctors have in common is that each was paid by a state Medicaid health insurance program after being kicked out of another state’s Medicaid system or the federal Medicare program.

More broadly, 32 states and the District of Columbia supplied data showing they paid at least $79 million to 269 of the 1,800 providers after their terminations elsewhere. But the data was incomplete. Extrapolating from what could be verified, Medicaid payments to banned providers could easily reach into the hundreds of millions of dollars.

Mind boggling incompetence? Or government business as usual?

Medicaid Block Grants = Unconstitutional Coercion?

Professors Sara Rosenbaum and Timothy Westmoreland have an interesting opinion piece in the New England Journal of Medicine with a curious response to the proposal that federal Medicaid funding should be re-structured as block grants (via the Patient CARE Act, proposed by some Congressional Republicans).

It is a pretty well established Republican proposal. It falls short of NCPA’s proposal to convert federal subsidies for health care into refundable tax credits. Nevertheless, it removes the perverse incentive for states to ramp up Medicaid spending beyond what is necessary to pull down more federal funds. In the current system, a state that spends one more dollar on Medicaid will attract between one and nine more federal dollars. This causes states to spend themselves into penury to recover federal dollars.

Ms. Rosenbaum and Mr. Westmoreland suggest that the same Supreme Court that ruled Obamacare’s expansion of Medicaid unconstitutional would do the same for block grants:

Churn: Data Lacking on Critical Question

The media and most health policy wonks focus only on the number of insured versus uninsured people. They don’t really care if people are enrolled in Medicaid, Medicare, Obamacare plans, employer-based benefits, or whatever. As long as the percentage insured goes up, they are satisfied.

One of the problems this disguises is “churn” – people moving between different types of coverage, which leads to disrupted care. It is something that Obamacare surely makes worse, by introducing a new type of coverage for people within a certain range of income.

However, the people in charge of the new system are almost completely ignoring this problem, according to Modern Healthcare:

Experts say churn can be disruptive to people’s continuity of benefits and healthcare, particularly if they have medical conditions for which they are receiving treatment. In addition, it can be harder for people to access healthcare providers, particularly specialists, if they switch to Medicaid, which often pays lower rates.

“For a patient under a physician’s care for a condition like cancer or renal failure, changing providers in the midst of chemotherapy or dialysis can be incredibly disruptive,” said Chris Stenrud, executive director of government relations at Kaiser Permanente.

A CMS spokesman said no data on churning between private plans and Medicaid were available for the nearly three dozen states using the federal marketplace. But a committee of health plans selling products on the federal exchange that has been tracking the trend has noted a small but steady exodus from exchange plans. The committee, however, could not determine whether the people exiting the exchange plans were transitioned to Medicaid or employer coverage or became uninsured.

The solution to churn is a refundable, universal tax credit that allows people to buy health insurance of their own choosing, and getting rid of the artificially fragmented market that Obamacare has made worse.

Medicaid Expansion Already Blowing Budgets

The Foundation for Government Accountability has examined every Medicaid expansion state with enrollment data available. The report:

discovered a systemic problem of under-projection and over-enrollment. The proponents of expansion have an incentive to keep their projections low when selling the massive welfare expansion to state lawmakers and the public, so the program appears less expensive than it really is.

The five states with the worst differences between projections and actual enrollment:

1) California’s enrollment more than doubled projections at 120 percent above projections.

2) Nevada missed the mark with enrollment, hitting 113 percent above projections.

3) Washington enrolled more than half a million people, exploding projections by 104 percent above projections.

4) Kentucky’s enrollment doubled projections in the first year by 100 percent above projections, costing taxpayers $1.8 billion more in the next fiscal year.

5) Illinois enrolled more than 600,000, exceeding projections by 83 percent above projections, raising the cost to taxpayers by $800 million.

Administration Plays “Medicaid Hardball” With Holdout States

Obamacare was supposed to dramatically increase Medicaid dependency in exchange for reducing some direct federal funding of hospitals. Now, some governors of states that rejected Obamacare’s Medicaid expansion are reacting negatively to the federal government’s cutting back hospital funding.

Governor Rick Scott of Florida is suing the federal government for proposing to cut Low-Income Pool (LIP) funding to hospitals, which he describes as retaliation for the state rejecting Medicaid expansion. Now, it looks like the Administration is issuing the same threat to Texas.

It is not clear why the Administration cares whether federal money sent to a state for health care is sent to Medicaid or directly to hospitals.

NCPA’s long-standing proposal for a universal, refundable tax credit addresses the issue as follows: If people do not claim the tax credit for health insurance, it gets sent to a safety-net facility where they reside. We haven’t gone deep into the details of how that gets executed. Although, my latest proposal is that all federal funding for welfare be bundled into unified Opportunity Grants

Obamacare’s Medicaid Expansion Does Less Than It Claims

I am still playing whack-a-mole with journalists and others who keep confusing Medicaid with health insurance. The latest is the coverage of the Urban Institute’s latest Health Reform Monitoring Survey. The Hill reported it as” “Uninsured rate falls by half in states that expanded Medicaid”.

Imagine if a state expanded cash welfare payments versus its neighbors. The media would report that the number of people reporting no cash income had dropped faster in that state, despite creating no jobs.