Category: Medicaid

Ani Turner of the Altarum Institute has examined the growth in healthcare jobs in states which expanded Medicaid versus those which did not expand Medicaid.

This preliminary analysis shows that the recent acceleration in health care job growth should not be attributed primarily to Medicaid expansion, in part because (1) overall job growth accelerated, (2) the impact of expanded coverage on demand may turn out to be small compared to other forces, and (3) an expanded coverage effect may be present in both groups of states to a greater extent than we expected. It is important to emphasize that this is not a test of whether expanded coverage increases jobs but whether the recent acceleration in health job growth can be attributed to expanded coverage, as measured by Medicaid expansion status.

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Another unintended consequence of Obamacare:

The enrollees who are at greatest risk are pregnant women, children and blind and disabled individuals who were enrolled in Medicaid prior to the effective date of two Patient Protection and Affordable Care Act provisions — the 2014 expansion of coverage to all adults with incomes up to 138% of the federal poverty level, and the establishment of a new formula to define household income under the Modified Adjusted Gross Income (MAGI) standard. (Virgil Dickson, Modern Healthcare)

One of the greatest harms that Obamacare has inflicted is to have increased the fragmentation of access to health insurance. People in the part-time working class will be the worst affected: Churning between Medicaid and Obamacare exchanges, maybe twice a year or more, depending on changes in their incomes.

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In accordance with federal law, Colorado hired Health Services Advisory Group (HSAG) to do an on-site review of Denver Health Medicaid Choice plan performance in 2013. Denver Health is one of Colorado’s biggest Medicaid contractors. It runs a hospital, a pharmacy, 9 satellite primary care clinics, 4 dental clinics, and 16 school-based health centers. HSAG’s report on Denver Health’s performance was published in April, 2014. All Medicaid clients with a Denver address are automatically enrolled in Denver Health Medicaid Choice unless they choose another Medicaid option. Denver Health scored well overall. It met 87 percent of all of the evaluative standards. Paperwork on coverage, utilization management, provider certification, and denial of claims documentation was in near perfect order. According to its annual Strategic Access Report, 99.8 percent of Medicaid members were within 30 miles of a Denver Health clinic and there were 54 bus stops within a quarter of a mile of its clinics. It had direct access to care for members with special needs, 24-hour emergency access, preventive health programs, and numerous “committees, workgroups, staff trainings, and evaluation of metrics regarding provision of interpreters and understanding of culture with respect to health care.”

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In 2013, many were surprised to learn that Oregon’s Medicaid expansion did not improve health outcomes. Subsequent research on the same data, published this year, found that low-income, uninsured adults newly covered by Medicaid go to the ER more, not less. As seen in the chart below (reproduced from the article), new Medicaid dependents increased their ED  visits by approximately 40% relative to those who did not enroll. This corroborates what hospitals are starting to admit.

Source: Straining Emergency Rooms by Expanding Health Insurance from Policy Forum.

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The Wisconsin Legislative Fiscal Bureau analysis estimates the state is losing about $100 million a year by not expanding its Medicaid eligibility as much as allowed under the Patient Protection and Affordable Care Act (ACA). This mudslinging by Wisconsin Governor Scott Walker’s gubernatorial challenger is disingenuous and ignores the fact that Wisconsin made a better choice by allowing many of its low-income uninsured to access private coverage with federal subsidies.

Over the past several years state legislators have grappled with the pros and cons of Medicaid expansion under the ACA. The carrot dangled in front of state legislators is financial; states that agree to expand Medicaid eligibility to 138 percent of the federal poverty level (FPL) can expect the federal government to reimburse states for most of the cost for newly eligible enrollees. Critics of Medicaid expansion counter that the savings are front-loaded in the early years, whereas state costs begin to rise in later years when it’s too late for states to back out. Whereas the federal government will pay 100 percent of the costs through 2016, the feds begin ratcheting the matching rate down to 90% by 2019.

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