Viewpoints: ‘Big Risks’ Of Buying Private Insurance With Medicaid Dollars; One Month Of Sequestration

US residents with employer-based private healt...

US residents with employer-based private health insurance, with self insurance, with Medicare or Medicaid or military health care and uninsured in Million; U.S. Census bureau: Income, Poverty, and Health Insurance Coverage in the United States: 2007 (Photo credit: Wikipedia)

Topics: Medicaid, Medicare, Health Reform, States, Health Costs, Women’s Health, Uninsured

Apr 01, 2013

The New York Times: Using Medicaid Dollars For Private Insurance
The Obama administration and Republican officials in several states are exploring ways to redirect federal money intended to expand Medicaid, the main public insurance program for the poor, and use it instead to buy private health insurance for Medicaid recipients. The approach could have important benefits for beneficiaries and for the future of health care reform. But the idea also carries big risks. Federal officials will need to enforce strict conditions before agreeing to any redirection of Medicaid dollars that were originally intended to enlarge the Medicaid rolls (3/31).

Forbes: The Arkansas-Obamacare Medicaid Deal: Far Less Than It First Appeared
When Arkansas Gov. Mike Beebe (D.) first announced that he had reached a deal with the Obama administration to use the Affordable Care Act‘s private insurance exchanges to expand coverage to poor Arkansans, it seemed like an important, and potentially transformative, development. … A Good Friday memo from the U.S. Department of Health and Human Services, however, splashes cold water on that aspiration. It’s now clear that the Beebe-HHS deal applies a kind of private-sector window dressing on the dysfunctional Medicaid program, and it’s not obvious that the Arkansas legislature should go along (Avik Roy, 4/1).

USA Today: ‘Sequester’ Still Looks Stupid, As Planned: Our View
Congress and the White House exempted some programs when they finalized the original deal, and the spending bill they agreed to last month to keep the government open to Sept. 30 spared some vital functions — food inspections, for example. But not enough. Nor does the sequester seriously address the major spending driver: health care costs. The best outcome would be for the sort of anger that forced Congress and the White House to re-open the government in 1996 to push Congress and the White House back to the table on a realistic budget deal this year. The outlines of that deal have been obvious for too long: Trim entitlement programs such as Medicare and Social Security, overhaul the hopelessly inefficient and corrupt tax code to bring in more money, and cut defense and domestic programs with a scalpel instead of an ax (3/31).

USA Today: ‘Sequester’ Needed To Rein In Spending: Another View
Let’s get real on the “sequester.” One month in, not much has changed. Nor is it likely to. Rather than devastating the federal government, the sequester is necessary to rein in the unbridled growth of federal spending. The sequester is certainly flawed. It’s a blunt instrument leaving the biggest spending drivers, entitlements, virtually untouched (Alison Fraser, 3/31).

The Wall Street Journal: The Liberal Medicare Advantage Revolt
A big political story this year is likely to be Democrats turning on their White House minders as the harmful and unpopular parts of the Affordable Care Act ramp up. On the heels of the recent 79-20 Senate uprising against the 2.3% medical device tax, now comes the surge of Democrats pleading on behalf of Medicare Advantage. Liberals have claimed for years to hate this program, but by now Advantage provides private insurance coverage to more than one of four seniors. And those seniors like it (3/29).

The Chicago Tribune: Scrubbing Medicaid
In January, Illinois launched an effort to scrub ineligible people from the state’s Medicaid rolls. … The initial results of this audit are … astonishing: Of the first 20,500 recipients screened by an outside contractor, the auditors recommend that 13,709 be removed from the rolls. Yes, that’s two-thirds of the first group screened, flagged as ineligible to receive their current Medicaid benefits. How so? In some cases, the recipients make too much money to qualify. In other cases, they don’t live in Illinois (3/31).

The New York Times: The Campaign to Outlaw Abortion
Anti-abortion groups have been trying to re-impose restrictions on abortion rights for 40 years, but the Legislature and governor of North Dakota have taken this attack on women’s reproductive health and freedom to a shocking new low … The clear message is the need for a stepped-up effort to hold state officials electorally accountable for policies that harm women in states where right-wing Republicans control the machinery of government (3/29).

The Seattle Times: State Senate Health Care Committee Should Vote On Abortion Measure
After the Senate Health Care Committee hearing on the Reproductive Parity Act Monday, members should vote for it before a key deadline Wednesday. State lawmakers do not need to complicate this issue. House Bill 1044 would maintain insurance coverage for women seeking abortions after federal health reforms take effect (3/31).

Los Angeles Times: The Starbucks Syndrome In Healthcare
Medicare statistics, for example, reveal that Los Angeles leads the nation in the amount of medical services provided during the last six months of a person’s life. Healthy seniors here are also big consumers of healthcare, getting about 65% more MRI studies and utilizing ambulances three times as often as seniors elsewhere. Commercial insurance data point to similar patterns in the healthcare of the younger population in Southern California. What explains such avid use of medical services. … Part of the problem is that Angelenos approach healthcare as they do other kinds of consumption. They expect their CT scans, when they want them, in much the same way they expect their decaf caramel extra hot low-fat macchiatos. (Daniel J. Stone, 3/31).

Los Angeles Times: Bump In The Road For Healthcare Law
One figure in a new report neatly summarizes the potential pitfalls for Obamacare: 30.1%. That’s how much premiums could rise next year, on average, for the roughly 1.3 million moderate- and upper-income Californians who buy individual health insurance policies. Most of that increase is attributable to the insurance reforms in the 2010 law, also known as the Affordable Care Act. The bill’s title is not ironic — its provisions will slow the growth of healthcare costs and lead over time to a more rational and efficient system. But the transition will have some rough patches, and we’re about to hit one (3/29).

Houston Chronicle: The Affordable Care Act Is A Poor Solution
Senator Orrin Hatch has speculated that the Affordable Care Act was designed to fail. A close look at the Act’s contents and history suggests he may be right. The Affordable Care Act is nothing more than a political stopgap, a waypoint on the road to something that might work. Republicans could stand around complaining or we could seize this opportunity to determine what comes next (Chris Ladd, 4/1).

Richmond Times-Dispatch: Moving Forward On Medicaid: More Important Than Ever
As a community physician for more than eight years, I’ve seen how medical care helps keep families strong and secure. When parents and their kids can access health care — and have a way to pay for it — they are much less likely to face unpaid bills or have to put off doctor visits. Instead of worrying about how their family is going to survive, they can focus on how their family is going to thrive. Unfortunately, too many Virginians — more than a million, in fact — find that getting health care is a real challenge because they don’t have insurance (Dr. Christopher Lillis, 4/1).

The Wall Street Journal: The Skinny On Anti-Obesity Soda Laws
New York Mayor Michael Bloomberg’s anti-obesity campaign to ban the sale of certain sugary drinks in large servings, especially sodas, was struck down last month in state court. A proposal for a penny-per-ounce excise tax on sweetened beverages also floundered in Vermont’s House of Representatives in February. … As an economist, I have two big gripes with such paternalistic public-health initiatives: The proposals aren’t grounded in data or compelling economic models, and soda taxes might catalyze a dismal chain reaction, with escalating government intrusions on personal freedom (Michael L. Marlow, 3/31).

Oregonian: Don’t Take Portland’s Sick-Leave Mistake Statewide: Agenda 2013
By voting to mandate paid sick leave last month, Amanda Fritz and her city council colleagues furthered Portland’s reputation as a place where businesses fear to tread. One way to protect city employers burdened by this mandate is to adopt a similar requirement statewide, erasing a competitive advantage a restaurant in, say, Beaverton might have over one in Portland. In other words, bail out Portland by making things tougher all over (3/31).

USA Today: ER Key To Curb Painkiller Abuse
Most opioids are prescribed in the doctor’s office, which has prompted some states to restrict primary care physicians like myself from prescribing them and to encourage referrals to pain specialists. New York City Mayor Michael Bloomberg has taken these curbs a step further by focusing on emergency departments. In January, he announced a voluntary initiative to limit prescription of opioid painkillers in the emergency rooms of the city’s 11 public hospitals. This approach should be expanded across the nation. From 2004 to 2009, the number of emergency visits in New York City hospitals related to opioid abuse or misuse more than doubled (Dr. Kevin Pho, 3/31).

This is part of Kaiser Health News’ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.


Arkansas’ ‘Third Option’ For Medicaid Expansion Draws Attention

Earl Ray Tomblin

Earl Ray Tomblin (Photo credit: Wikipedia)

Topics: Medicaid, Politics, Health Reform, States

Mar 26, 2013

The approach, which is under consideration by state lawmakers, has attracted the interest of conservative governors and legislators in other states who had previously opposed the program’s expansion. Meanwhile, news outlets track Medicaid expansion news from Iowa and West Virginia.

NPR: Arkansas Medicaid Expansion Attracts Other States’ Interest
Since the Supreme Court made the Medicaid expansion under the federal health law optional last year, states’ decisions have largely split along party lines. States run by Democrats have been opting in; states run by Republicans have mostly been saying no or holding back. But now Arkansas – at the suggestion of the federal government – has suggested a third option: Enroll those newly eligible for Medicaid in the same private insurance plans available to individuals and small businesses. And some think that could shake things up. A lot (Rovner, 3/26).

The Associated Press: Ark. GOP Leader Floats Special Session On Medicaid
The top Republican in the Arkansas House on Monday said lawmakers should delay taking final action on a proposal to expand health insurance to low-income residents so state officials can answer questions about how the program would operate. Democratic Gov. Mike Beebe quickly dismissed the idea, repeating his call for lawmakers to vote on the proposal before the end of this year’s legislative session (3/25).

The Associated Press: Iowa Senate Backs Medicaid Expansion Legislation
Lawmakers in the Democratic-controlled Senate approved an expansion of Iowa’s Medicaid program Monday, though Republican Gov. Terry Branstad remains firmly opposed to growing the program in the state. In a 26-23 vote, split down party lines, the Senate backed the legislation. During the 90-minute debate, Democratic lawmakers argued that expanding Medicaid will provide care to more low-income Iowans with little cost to the state (3/26).

Des Moines Register: Senate Approves Medicaid Expansion Plan
The Iowa Senate approved legislation Monday night to add more than 100,000 low-income Iowans to the state-federal Medicaid health insurance program, setting up a showdown with Gov. Terry Branstad. Senate File 296 was approved 26-23 on a straight party line vote with Democrats in favor and Republicans against (Petroski, 3/25).

The Associated Press: W. Va. Diocese Joins Call For Expanding Medicaid
The leader of West Virginia’s Roman Catholic community has joined the chorus urging Gov. Earl Ray Tomblin to expand Medicaid to cover more low-income residents. Bishop Michael J. Bransfield wrote the governor Friday, citing deep concerns about the health and wellbeing of West Virginians he’s developed in his eight years with the Diocese of Wheeling-Charleston and its 83,000 or so Catholics (3/26).

And, on the topic of health exchanges –

The Associated Press/Washington Post: Maryland House Passed Bill Further Implements Health Care Reform
A measure to further implement federal health care reform in Maryland passed the House of Delegates on a 93-43 vote Monday with little debate. The measure creates a dedicated funding stream for the Maryland Health Benefit Exchange, which is a new insurance market that will offer residents a choice of private health plans. While the exchange is on track to be up and running by Jan. 1 with federal help in the first year, the state will begin paying roughly $24 million in fiscal year 2015. The money will come from an existing 2 percent tax on insurance plans that are state-regulated (3/25).

Arkansas Medicaid Plan, Born Of Necessity, Shakes Things Up

English: Great Seal of the State of Arkansas

English: Great Seal of the State of Arkansas (Photo credit: Wikipedia)

By Julie Rovner, NPR News

March 26th, 2013, 9:13 AM

This story comes from our partner ‘s Shots blog.

Since the Supreme Court made the� Medicaid expansion under the federal health law optional last year, states’ decisions� have largely split along party lines. States run by Democrats have been opting in; states run by Republicans have mostly been saying no or holding back.

Illustration by Darwinek via Wikimedia Commons

But now Arkansas – at the suggestion of the federal government – has suggested a� third option: Enroll those newly eligible for Medicaid in the same private insurance plans available to individuals and small businesses.

And some think that could shake things up. A lot.

The Arkansas proposal was crafted as much out of political necessity as from substantive desire, says Andy Allison, the state’s Medicaid director.

“I think this is likely to be the only way that expansion or coverage for this population could occur,” he says.

There are two reasons for that. One is that the state has a Democratic governor (Mike Beebe, now serving his second term), but a heavily Republican state legislature, which has� not looked favorably on expanding Medicaid.

A second reason is that few adults currently qualify for Medicaid in Arkansas. And those who do have to be really poor, says Allison: “We cover just at 17 percent of the poverty level for those who are parents and we don’t cover childless adults unless they have a disability.”

For the record, 17 percent of poverty is less than $2,000 a year. Expanding Medicaid under the Affordable Care Act to 133 percent of poverty — about $15,000 — could potentially add as many as 250,000 Arkansans to the rolls.

But what was a political nonstarter gained new life when someone suggested the idea of enrolling those new people in the same private plans individuals and small businesses will be purchasing — the� new marketplaces, called exchanges.

So far the state has gotten a� tentative go-ahead from the U.S. Department of Health and Human Services. That’s caught the attention of several other Republican-run states that had been holding out on the Medicaid expansion, including Ohio, Florida, and even Texas.

But experts insist the proposal is hardly as new as some have suggested.

“The authority to use Medicaid funds to buy insurance has been in the law since it was first enacted,” said� Sara Rosenbaum, a law professor and Medicaid expert at the George Washington University.

Still, when the Arkansas arrangement first went public about a month ago, there was some immediate hand-wringing about its potential cost.

“We have to … recognize that it will cost more,” said� Austin Frakt, a Boston University health economist. “You don’t get something for nothing.”

But Frakt concedes that paying somewhat more — how much more remains a subject of contention — might not be all bad.

“One of the basic critiques of the Medicaid program is they pay providers too little and that’s why too few of them participate,” he said.

So putting people in private plans with higher provider payments could help address those access problems.

Meanwhile, Medicaid watchers say proposals like the one in Arkansas could solve other problems — for the new Medicaid recipients and for the others who will be buying coverage in the new exchanges.

One potential problem the private plans could address is called� churning. It happens when a person’s income is near the threshold between qualifying for Medicaid and qualifying for� federal help to buy private coverage.

Imagine, says Rosenbaum, someone working 30 hours a week in the summer, whose hours are cut back so they qualify for Medicaid part of the year, then expanded, pushing them back out of the program.

“And you get a letter saying, ‘Now you’re earning more money, so now you have to leave your plan. You and your kids have to leave your doctors; you have to pick a new plan.’ And then in winter, if your hours drop back down, you get another letter saying, ‘Oh, sorry, you have to leave your plan, [and] your doctors,’ ” she says. “Those people could be forced to change plans multiple times a year.”

Rosenbaum says enrolling Medicaid beneficiaries in plans in the exchange instead could protect as many as 28 million people a year from churning if their income does get too high.

“Your plan will stay your plan, your doctors will stay your doctors,” she said. Basically the “bank of Medicaid” and the “bank of the exchange” will have a conversation with each other about who pays the bills. And your premium may be a little bit different and your co-pays may be a little bit different, but your healthcare won’t be interrupted.”

And it’s not just those on Medicaid who could benefit.

Many of the new Medicaid enrollees will be relatively healthy, relatively young people with relatively low insurance costs. They could help bring premiums down for those in the exchanges who are older and sicker.

“It’s the woman who’s 32 working at Wal-Mart with a couple of kids who we really need in the exchange,” Rosenbaum says. “And so if we buy her in and keep her in, it’s going to be that much better off for the 55-year-old woman who is sick and unable to work and needs coverage through the exchange because of a lot of health conditions. ”

Still, one of the fundamental appeals of putting new Medicaid enrollees in private plans remains political.

“I think in states where the resistance to the Medicaid expansion was based primarily on ‘This is a big government program that we can’t make any bigger,’ finding a way to do the expansion through private coverage will open a door to a conversation that was otherwise not taking place,” said Alan Weil of the� National Academy for State Health Policy.

What remains a key issue for many states, however, is that the federal government hasn’t yet said exactly how much states can spend on the private plans — only that what they spend to enroll Medicaid beneficiaries in the plans should be “comparable” to what they would have spent otherwise.

Health and Human Services Secretary Kathleen Sebelius says officials will spell out more details on that issue “in the very near future.”

Some Republicans Propose Using Medicaid Expansion Dollars For Private Insurance

US residents with employer-based private healt...

US residents with employer-based private health insurance, with self insurance, with Medicare or Medicaid or military health care and uninsured in Million; U.S. Census bureau: Income, Poverty, and Health Insurance Coverage in the United States: 2007 (Photo credit: Wikipedia)

Topics: Health Costs, Insurance, Medicaid, Politics, Health Reform, States

Mar 25, 2013

Some governors who initially opposed the health law’s Medicaid expansion are proposing to use the federal money to allow low-income people to buy private insurance in the new exchanges. News outlets report on those and related developments in Tennessee, California, Missouri, Florida and Kansas.

The Associated Press/Washington Post: Republicans’ Firm ‘No’ On Medicaid Expansion Is Shifting Toward ‘Let’s Make A Deal’
A new “no, but …” approach is spreading among GOP states in which officials are still publicly condemning the Democratic president’s Medicaid expansion yet floating alternatives that could provide health coverage to millions of low-income adults while potentially tapping into billions of federal dollars that are to start flowing in 2014 (3/24).

Stateline: Expanding Medicaid With Private Insurance
The governors of Ohio and Arkansas, seeking a way around conservative state legislators who refuse to expand Medicaid, want to insure some of their poorest residents using a market-based approach. The federal government appears likely to allow Republican Governor John Kasich of Ohio and Democratic Governor Mike Beebe of Arkansas to use federal Medicaid dollars to purchase private health insurance for low-income people from the new health-care “exchanges” that will be created under the Affordable Care Act. They plan to use the strategy to cover newly eligible adults making up to 138 percent of the federal poverty level (Vestal, 3/22).

The Wall Street Journal: Medicaid-Expansion Puzzle
Deciding whether to expand Tennessee’s Medicaid program as part of the federal health-care law should be easy for Republican Gov. Bill Haslam and the GOP leaders of the state legislature. All of them oppose the health law. They watched the state significantly extend eligibility in the 1990s for its Medicaid program, TennCare, only to see costs eat into the state budget and prompt lawmakers a decade later to kick several hundred thousand people off the rolls. But the decision is proving anything but simple (Radnofsky, 3/24).

The New York Times: Tennessee Race for Medicaid: Dial Fast and Try, Try Again
Two nights a year, Tennessee holds a health care lottery of sorts, giving the medically desperate a chance to get help. State residents who have high medical bills but would not normally qualify for Medicaid, the government health care program for the poor, can call a state phone line and request an application. But the window is tight — the line shuts down after 2,500 calls, typically within an hour — and the demand is so high that it is difficult to get through (Goodnough, 3/24).

Los Angeles Times: Outreach Effort Aims To Get Uninsured Enrolled In Healthcare
The goal is to hold ongoing enrollment events throughout the county in the lead up to the healthcare overhaul, which begins Jan. 1. … The county Department of Health Services has partnered with OneLA, an organization of churches, synagogues and nonprofit groups, to conduct the enrollment sessions. Volunteers are identifying people through the church parishes and doing pre-screening so the enrollment can occur on the spot. Some of the people are eligible for Medi-Cal, and others are being enrolled in Healthy Way LA, a temporary coverage program until the Medi-Cal expansion takes place in 2014 (Gorman, 3/25).

St. Louis Beacon: Mental Health Patients, Advocates Make Case For Expanding Medicaid In Missouri
William Shortall is among 50,000 Missourians who are in a bind because they don’t have sufficient insurance to cover treatment for their mental health problems…The Affordable Care Act was supposed to throw a lifeline to people like Shortal by extending Medicaid to uninsured Missourians with incomes up to 138 percent of poverty, which is roughly $26,000 for a family of three (Joiner, 3/22).

Health News Florida: Senate Republicans, Democrats Back ‘Healthy FL’
State Sen. Joe Negron‘s “Healthy Florida” plan, officially launched without dissent Thursday by the Senate Appropriations Committee, has already attracted support from a broad swath of industries and leaders of both political parties (Gentry, 3/22).

Kansas Health Institute: House Speaker Talks About Medicaid Expansion, Reading Initiative, Autism Mandate
House leaders today expressed support for a Senate budget provision that would bar expansion of the state’s Medicaid program without the Legislature’s OK. House Speaker Ray Merrick, a Stillwell Republican, said he sided with language added to the Senate budget bill Thursday that would bar state agencies from spending any money to expand eligibility for the Kansas Medicaid program without the expressed consent of the Legislature (Ranney, 3/22).

This is part of Kaiser Health News‘ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

Medicaid News: Fight Over Expansion Brews In Ark.

Topics: Medicaid, Politics, States, Delivery of Care, Health Costs

Sep 12, 2012

State Medicaid budget issues show promise in Colorado — where a cost savings program may be working — and North Carolina — where the program has spent less than anticipated.

The Denver Post: Key Medicaid Reform Effort In Colorado Shows Promising Savings
Colorado’s key Medicaid-reform effort — matching thousands of state-supported patients to “medical homes” and careful case management — is showing promising savings, health officials will report to the legislature this fall. More than 128,000 Medicaid clients are enrolled in seven case management regions, and preliminary data for the first six months of billing shows a 14 percent drop for inpatient hospital stays among children, state officials said (Booth, 9/12).

North Carolina Health News: Medicaid Program In The Black — Just
Spending in the state’s Medicaid program is down slightly in the past two months, a state health official told lawmakers Tuesday. During a meeting of the Health and Human Services oversight committee at the state legislature, Medicaid chief business officer Steve Owen told lawmakers that compared to budget projections, the program had spent about $4 million dollars less than forecast (Hoban, 9/11).

In the meantime, a fight brews between Arkansas’s governor and the legislature over whether to implement the health law’s Medicaid expansion there —

The Associated Press: Governor Supporting Expansion Of Medicaid
Gov. Mike Beebe said Tuesday he supports expanding Medicaid eligibility in Arkansas under the federal health care law after officials assured him the state could later opt out, setting up a potentially heated fight with Republican lawmakers as they try to win control of the state Legislature. Beebe, a Democrat who had said he was inclined to support the expansion, said he decided to back it after receiving those assurances in writing from the federal government. Beebe noted that the expansion will still require support from state lawmakers next year (9/12).

This is part of Kaiser Health News‘ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

Logo of the United States Department of Health...

Logo of the United States Department of Health and Human Services. The symbol represents the American People sheltered in the wing of the American Eagle, suggesting the Department’s concern and responsibility for the welfare of the people. The logo is the department’s main visual identifier; the seal is now used for mainly legal purposes. The color can be either black or reflex blue. More information here and here. (Photo credit: Wikipedia)