Medicaid is the single largest component of state expenditures, accounting for 23.5 percent of the $1.7 trillion spent by states in 2013.
Largely as a consequence of the ACA, state and local spending for Medicaid is projected to nearly double over the next decade.
According to a Merritt Hawkins’ 2014 survey of the proportion of physicians in five specialties (cardiology, dermatology, orthopedic surgery, ob/gyn, and family practice) accepting Medicaid patients dropped from 55.4 percent in 2009 to 45.7 percent — a drop of almost one fifth.
This decline under the Obama administration contrasts with some improvement in Medicaid patients’ access during the second term of the Bush administration: Merritt Hawkins’ 2004 survey reported that 49.8 percent of physicians accepted Medicaid patients.
Merritt Hawkins also asked physicians if they were willing to accept Medicare patients: Only 76 percent said yes. In Minneapolis, only 38.2 percent of physicians were willing to accept Medicare patients! (Unfortunately, the survey did not ask physicians if they accept private insurance.)
As in 2009, Boston had the longest waiting times to see specialists at 1 ½ months.
The table below shows the waiting times for physicians in ten cities surveyed in both 2014 and 2009:
We’ve already noted that health spending last quarter climbed at the highest rate in ten years, according to the Bureau of Economic Analysis’ latest quarterly GDP report.
Ben Casselman of FiveThirtyEight puts that spending spurt in another context. Examining the BEA’s February income report, he concludes that Medicaid expansion explains most of the growth:
The government’s definition of income includes not just salaries and other cash payments but also non-cash benefits such as employer-paid health insurance premiums and government programs such as Medicare and Medicaid. The health law has a particularly big impact on that last category because it made millions more people eligible for Medicaid. As a result, Medicaid payments increased $11.4 billion in February, representing 24 percent of the total increase in income. In January, Medicaid benefits represented an even bigger 47 percent of the increase in income.
In other words, the Bureau of Economic Analysis does not take into account whether people earned their income, or whether it was a welfare payment.
This is from the latest MACPAC report:
So far, Maine has resisted the temptation to grab new federal Medicaid dollars dangled by ObamaCare. However, due to relentless lobbying by hospitals and other interest groups that profit from taxpayers’ dollars, leaders in the Legislature are threatening to interfere with executive authority by introducing a bill to cancel a contract with a consultant who told the truth about the damage Medicaid is doing to Maine’s prosperity.
Expanding MaineCare (as Medicaid is called there) will not only burden state taxpayers; it will also increase inappropriate use of emergency rooms, decrease access to care for Maine’s most vulnerable residents, decrease private coverage, and even increase unemployment.
In a previous post I reported that health benefits for government workers cost 40 percent more than benefits for private-sector workers. This extra cost imposes a significant burden on taxpayers. Researchers at the Pew Charitable Trusts have now answered another, related question: How does spending on health benefits for state and local government workers compare with spending on Medicaid?
In a recent report, the researchers conclude that state and local spending on government workers increased by 444 percent in real, inflation-adjusted terms from 1987 through 2012. Spending on Medicaid grew by 375 percent.
That is, spending on government workers increased almost 20 percent more than spending on Medicaid. Free-market reformers continuously promote the idea of getting people off Medicaid, which is a bloated welfare program. However, we should be increasingly concerned with spending on government workers.
Although half the newly insured under the Affordable Care Act will be enrolled in Medicaid and although substance use disorder (SUD) is more common among the poor,
[f]orty percent of counties in the U.S. [the goldenrod counties in the figure below] do not have an SUD treatment facility that provides outpatient care and accepts Medicaid. Counties in rural areas are much more likely to lack access to outpatient SUD facilities that accept Medicaid, particularly those in Southern and Midwestern states. Our findings also indicate that gaps in the SUD treatment infrastructure are further compounded for areas with a higher proportion of racial and ethnic minorities.
Between one million and two million U.S. residents enrolled in Medicaid last year for reasons associated with the Affordable Care Act, according to an Avalere Health study released Wednesday…
The estimates are lower than the 6.3 million Medicaid enrollees recently touted by the Obama administration…
Further, the study estimates that around five million people will enroll in Medicaid coverage by the end of 2014, which is below a Congressional Budget Office estimate that eight million people will enroll in the program by the year’s end. (American Health Line)
New Medicaid patients in Oregon failed to use their benefits effectively because they did not understand how to use insurance or health care, according to a study released Monday in the journal Health Affairs. As a result, researchers told USA Today, patients did not receive preventive health screenings, schedule appointments to manage chronic illnesses or use their new insurance coverage for anything beyond medical emergencies.
In 1993, concerned about rising Medicaid costs, Congress made it mandatory for states to try to recover money from the estates of people who used Medicaid for long-term care, which can cost taxpayers hundreds of thousands of dollars per person. They included exceptions in cases in which there is a surviving spouse, a minor child and other situations.
Congress also gave states the option to go further — to target the estates of all Medicaid recipients for any benefits they received after age 55, including routine medical care. Many states took that route, including Oregon, which from July 2011 to June 2013 recovered $41 million from about 8,900 people.
The argument had been that “if you’re receiving a public benefit and the state is trying to support you, you should give back if you are able,” said Judy Mohr Peterson, Oregon’s Medicaid director. (Washington Post)
