Why Medicaid Patients Go to the ER, and Other News
Why Medicaid patients go to the hospital emergency room: they can’t get care anywhere else.
Obama budget defeated 99-0 in Senate.
Tag: "Medicaid"
May 22, 2012 | 4 comments | by John Goodman
Cost Shifting is Real
Roughly half of Medicare beneficiaries under age sixty-five are also eligible for Medicaid. These “dual eligibles” have been the subject of much research because of their low income and poor health status. Previous studies suggest that some states seek to shift costly health care services for this group out of state-run Medicaid programs and into the federally funded Medicare program—for example, replacing nursing home care with hospital care. Using state-level data on dual eligibles under age sixty-five, we found support for this hypothesis. In states with below-average per capita Medicaid spending, corresponding Medicare spending was above average. These state-level estimates also revealed a nearly threefold difference in total—Medicare plus Medicaid—price-adjusted spending per person, ranging from $16,309 in Georgia to $43,587 in New York.
Study on state spending on “dual eligibles” in Health Affairs.
May 17, 2012 | 4 comments | by John Goodman
EHR SNAFU
In our analysis of a 2011 nationally representative survey of office-based physicians, we found that 91 percent of physicians were eligible for Medicare or Medicaid meaningful-use incentives. About half of all physicians intended to apply. However, only 11 percent both intended to apply for the incentives and had electronic health record systems with the capabilities to support even two-thirds of the stage 1 core objectives required for meaningful use.
Full Health Affairs study on federal incentive programs.
May 11, 2012 | 5 comments | by John Goodman
Barney Frank on Health Care, and Other Links
Barney Frank on health care: “Obama made the same mistake Clinton made.”
The latest in rationing by waiting at Walt Disney World.
An accountant explains the federal budget. Thanks to John Dunn for the pointer.
In defense of oil speculation. HT: Greg Mankiw.
Apr 26, 2012 | 2 comments | by John Goodman
Making Flexible Spending Accounts Better
This is from my post at the Health Affairs Blog. More on this next week.
There is something rather simple the Obama administration could do that would have a very large impact on health care spending. Apparently, this is something that can be done administratively, without Congressional action. The simple step: Allow deposits to Flexible Spending Accounts (FSAs) to roll over at year end and grow tax-free.
Currently, there are about 25 million people with an HSA or HRA account (roughly evenly split) and another 35 million people with FSAs. That means that over half the people with a health account have an incentive to spend rather than to save. If FSAs could roll over and become use-it-or-save-it accounts:
- There would be a huge immediate impact on the incentives of the 35 million current account holders; instead of end-of-year wasteful spending, they would be tempted to save for more valuable future health care spending.
- Employers across the country would consider integrating these accounts into their health plans, making employer contributions to them and experimenting with new health plan designs.
Moreover, employers and their employees would have a vehicle much better than any option currently available to them to control health care spending:
- FSAs could be combined with high deductibles, allowing employees to directly control, say, the first $2,500 of spending without all of the pointless restrictions that hamper the usefulness of HSAs.
- FSAs could be created to allow employees control of whole areas of spending, say, all preventive care and all diagnostic tests — services for which individual discretion is both possible and desirable.
- FSAs could be created for the chronically ill — allowing, say, diabetics or asthmatics to manage their own health care dollars, much as home-bound, disabled Medicaid patients manage their own budgets in the Cash and Counseling programs.
- FSAs could be combined with value-based purchasing insurance plans — where the insurer only pays, say, for certain drugs, doctors and hospitals, but allows patients to add money out-of-pocket and make other choices — thus allowing the development of a real market for more expensive health care services.
Apr 24, 2012 | 4 comments | by John Goodman
This is Where Half of the Newly (ObamaCare) Insured are Headed
Medicaid beneficiaries are nearly twice as likely as individuals with private health insurance to face barriers to primary health care, and visit emergency departments for care much more frequently, according to a study published in the Annals of Emergency Medicine.
Full study by Paul Cheung, Jennifer Wiler, Robert Lowe and Adit Ginde on the barriers affecting Medicaid beneficiaries’ utilization of primary care worth reading.
Mar 21, 2012 | 7 comments | by John Goodman
Is ObamaCare’s Medicaid Expansion Constitutional?
David Kopel and Rob Natelson are internationally known experts on Constitutional law at the Independence Institute. They have submitted an amicus brief on the Medicaid mandate currently before the Supreme Court in State of Florida v. Department of Health and Human Services, et al. Rob Natelson provides his summary of the brief.
Based on a close reading of founding era documents, they argue that ObamaCare’s mandate to expand Medicaid eligibility levels or lose all Medicaid funding is unconstitutional. The “Founding-Era record reveals a specific understanding that especially in the area of social services, the states could make free decisions, uncoerced by the federal government.” Given that Medicaid has eliminated huge numbers of state and local programs designed to help those most in need with what is arguably among the most expensive and most poorly run programs in the federal government, the Founders may have had a point.
Mar 19, 2012 | 7 comments | by Linda Gorman
Medicaid Cancer Study
Tell me again why I should be glad that 16 million new people are going to be enrolled in Medicaid?
Medicaid patients had worse survival rates than the rest of the study sample, which included both those with private insurance and with no coverage at all. The disparities persisted even after the researchers controlled for where patients live, how much education they had received and the income level of their neighborhoods.
More on this study, and full article by Sarah Kliff in The Washington Post.
Feb 21, 2012 | 7 comments | by John Goodman
Is ObamaCare’s Medicaid Expansion Constitutional?
This is actually a more interesting question than I originally thought. Here is Robert Book at the Apothecary:
The health reform law passed in March 2010 provides for a substantial expansion of the “must cover” population – essentially anyone from a family with income below 138% of the federal poverty line (an amount that varies based on family size). This is a major component of the health reform law: according to the Congressional Budget Office, half the uninsured who they project to become covered as a result of new law will obtain coverage because of the Medicaid expansion…
The constitutional issue, however, is what would happen if a state declined to pay for that portion of the Medicaid expansion not paid for by the federal government? Suppose, for example, a state decided to just forgo the expansion entirely, on the grounds that it could not afford to pay its share of the cost? In that case, the health reform law contains a built-in retaliation – the state would lose all federal Medicaid funding.
Feb 03, 2012 | 8 comments | by John Goodman
Who Gets Welfare?
Source: Census Bureau
The chart shows the percent of households receiving a benefit in each of the education categories. For example:
Over a third of households with heads whose formal education was limited to a high school diploma — the most common type of household — received at least one of these types of assistance in 2010. A majority of households with heads who stopped their schooling before graduating from high school received government assistance in 2010.
Total assistance was about $600 billion in 2010 and it went to almost one half the population.
Source: University of Chicago professor Casey Mulligan at The New York Times’ Economix blog.
Feb 03, 2012 | 5 comments | by John Goodman
