Tag Archives: Block Grant Medicaid

10 Things to Know about Medicaid: Setting the Facts Straight

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http://kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-setting-the-facts-straight/?utm_campaign=KFF-2016-The-Latest&utm_source=hs_email&utm_medium=email&utm_content=51786609&_hsenc=p2ANqtz-_oPtCIH4gD4_ZRyWy2daz24TEoKyI_CXQyh75K4bbtRgDPBGs30nDlGsRdOe65M92Zu9Dja6Bmtm3TTQoDua3ac_xORQ&_hsmi=51786609

Medicaid, the nation’s public health insurance program for low-income children, adults, seniors, and people with disabilities, covers 1 in 5 Americans, including many with complex and costly needs for medical care and long-term services. Most people covered by Medicaid would be uninsured or underinsured without it. The Affordable Care Act (ACA) expanded Medicaid to reach low-income adults previously excluded from the program and provided federal funding to states for the vast majority of the cost of newly eligible adults.

President Trump and other GOP leaders have called for far-reaching changes to Medicaid, including caps on federal funding for the program. In the debate about Medicaid’s future, some critics of the program have made statements that are at odds with data, research, and basic information about Medicaid. To inform policy decisions that may have significant implications for Medicaid, the low-income people it serves, and the states, this brief highlights 10 key Medicaid facts.

 

No, Medicaid isn’t broken

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https://www.axios.com/no-medicaid-isnt-broken-2404950733.html

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One reason the architects of the American Health Care Act want to cut Medicaid spending and give more responsibility to the states is that they believe that the current program is “broken,” with inadequate access to physicians and out-of-control costs. This is one of those canards that is repeated so often that many people just accept it as true. Mostly, it is not true.

Like any big messy public program, Medicaid is very far from perfect, as I learned when I oversaw a Medicaid program for a Republican governor in New Jersey. But on basic measures of access and satisfaction with care, Medicaid beneficiaries look very much like people with private employer coverage despite the fact that they are sicker and poorer. And they’re doing better than the uninsured.

The bottom line: Medicaid isn’t broken — at least, not any more than private insurance is.

Finding doctors: The biggest problem that’s usually cited with Medicaid is that people have trouble finding doctors who will take them. And there are troubles with low Medicaid provider reimbursement rates and physician access, but they vary around the country. It’s not hard to find a state, or more typically a region within a state, where physician access is a real problem.

But overall:

  • 74% of Medicaid beneficiaries see a doctor each year
  • 69% for people with employer based private coverage see a doctor each year.
  • People on Medicaid are also nearly just as satisfied with their health care as people with employer coverage.

Costs aren’t out of control: Medicaid spending did jump to 10.5% in 2015 with the Affordable Care Act coverage expansion, but it dropped to 5.9% in 2016 and is projected to grow by 4.5% this year.

And per capita Medicaid costs are not rising faster than costs for private insurance. In fact, they’re projected to grow more slowly.

Some would say that’s because Medicaid underpays providers, and it does pay substantially less than Medicare in many states. Others would say, good for Medicaid; it drives a tougher bargain with providers while getting results comparable to other payers.

The AHCA would take more than 800 billion dollars out of Medicaid over the next decade by reducing funding for the Medicaid expansion and capping federal Medicaid spending. The architects of the AHCA may believe Medicaid dollars are better spent elsewhere or not spent at all, or that somehow states can make Medicaid work better with far less money.

There are many principled conservative arguments for smaller government. But the argument that Medicaid is “broken” is not one of them; it is more urban legend than fact.

Rival Senate healthcare group seeks to make waves

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Rival Senate healthcare group seeks to make waves

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A rival group of Republican senators is seeking leverage to influence the direction of the Senate’s ObamaCare replacement bill.

The group, led by Sens. Susan Collins (R-Maine) and Bill Cassidy (R-La.), has been meeting “a couple times a week,” according to Sen. Shelly Moore Capitol (R-W.Va.).

Cassidy is a physician and Collins is a former state insurance commissioner. Both have been outspoken opponents of the House-passed American Healthcare Act, and have co-sponsored their own version of an ObamaCare repeal bill called the Patient Freedom Act.

Cassidy told The Hill he and Collins have been meeting with Senate leaders to talk about their legislation. However, he noted the politics of the Senate mean that every member’s voice matters.

“When you only have 52 senators, everybody has significant leverage. That tight vote margin means everyone is essential,” Cassidy said.

The main GOP working group on healthcare includes 13 men backed by Senate leadership who are seeking to bridge the divide between conservatives and centrists.

What ever legislation emerges from that group is likely to be the bill that comes to the Senate floor.

But if all of the Senate’s Democrats oppose the measure, Senate Majority Leader Mitch McConnell (R-Ky.) will only be able to afford two defections.

That gives the other group leverage.

“Let’s look at it practically,” Capito  told The Hill. “You can only lose two votes on any one issue … so I think a bloc of four or five can be very effective.”

Health lobbyists have noted many members of the leadership-led group have been fairly measured in their criticisms of the House bill approved earlier this month.

Collins and Cassidy, in contrast, both seem keen on turning sharply from the House bill.

Revised ACA Repeal-and-Replace Bill Likely to Increase the Uninsured Rate and Health Insurance Costs for Many

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http://www.commonwealthfund.org/publications/blog/2017/apr/amendment-aca-repeal-and-replace-bill

News outlets report that House Republicans are close to agreeing on an amended version of the American Health Care Act (AHCA), their proposed repeal and replacement of the Affordable Care Act (ACA). The all-important legislative language for the revised bill is not yet available, nor are Congressional Budget Office (CBO) projections of its effects on coverage and the budget, so any analyses are necessarily tentative.

Nevertheless, the summaries leaked to the media offer insight on the amended bill. If accurate, those summaries suggest that the revised AHCA will significantly increase the numbers of uninsured Americans, raise the cost of insurance for many of the nation’s most vulnerable citizens, and, as originally proposed in the AHCA, cut and reconfigure the Medicaid program. The new amendment specifically allows states to weaken consumer protections by, for example, permitting insurers to charge people with preexisting conditions higher premiums.

What the Amendment Leaves in Place

The amended proposed bill does little to change many provisions of the original AHCA including:

The CBO estimated in March that the combined effects of these provisions would increase the number of people without health insurance by 24 million by 2026. Older Americans would be particularly hard hit by the bill, experiencing much higher premiums relative to the ACA and the greatest coverage losses.

What the Amendment Changes

The amendment offers states the option to apply for waivers to reduce ACA consumer protections that have enabled people with health problems to buy private health insurance. States could waive the ban on charging people with preexisting conditions higher premiums, as long as states set up high-risk pools for people with conditions like cancer or heart disease who could no longer afford coverage. States could also change the ACA’s required minimum package of health benefits for health plans sold in the individual and small-group markets.

Despite the fact the federal ban on preexisting condition exclusions would remain under the AHCA, as Tim Jost points out, insurers could reach the same end by not covering services like chemotherapy that sick people need, or by charging very high premiums for individuals with expensive, preexisting problems. In addition, waiving the ACA’s essential benefit requirement could weaken other consumer protections like bans on lifetime and annual benefit limits and caps on out-of-pocket costs.

While states that allowed higher premiums for people with health problems would be required to use a high-risk pool under the amendment, prior research has found that such pools operated by states before the ACA were expensive both for states and for people enrolled in them, and covered only a small fraction of the individuals who would have benefited. An amendment proposed earlier in the month would provide federal funds for a so-called “invisible risk-sharing” program, a hybrid between a high-risk pool and reinsurance for high claims costs, but the allocated funding would likely need to be much higher to have an impact on costs.

The number of states that would apply for these waivers is unknown, but it seems reasonable to expect that many states with governors and legislatures that have opposed the ACA would do so. For a substantial part of the country, therefore, the amendment could seriously undermine the ACA’s protections for people with preexisting health conditions.

 

Block grant funding of public health insurance: the Canadian example

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Block grant funding of public health insurance: the Canadian example

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Speaker Paul Ryan wants to reform Medicaid by “block granting” the program, that is,

by capping federal funding and turning control of the program over to states. The aim of such reforms is to reduce federal funding over the long term, while preserving a safety net for needy, low-income Americans. An additional valuable aim of this effort has been to advance federalism by reducing the federal government’s role and giving states and governors more freedom and flexibility in managing their Medicaid programs and helping people in their states.

What are the likely consequences of block granting? Benjamin Sommers and David Naylor write in JAMA about how Canada’s joint federal/provincial funding of health care provides lessons about the likely consequences of block granting.

Canada is a single payer health care system. However, there isn’t a Canadian single payer. Rather, there is a single payer for each province: I am covered by the Ontario Health Insurance Plan (OHIP). These plans are primarily funded by provincial taxes. However, provinces also receive a health transfer from the Canadian federal government, i. e., a block grant. The provincial health insurance plans are run by provincial health ministers, not the federal minister in Ottawa.

So, does provincial autonomy facilitate experimentation and tailoring by the provinces? Sommers and Naylor think not.

there is little evidence that the alleged advantages of block grants have materialized in Canada. Advocates argue that with greater flexibility and proper incentives, states can reduce costs by improving the efficiency of care. In Canada, however, the provinces’ primary means of coping with budget pressures under block grants has been to reduce funding to hospitals and bargain harder with provincial medical associations. Ironically, then, if this scenario plays out in the United States, it would exacerbate one of the chief Republican criticisms of Medicaid — that it pays clinicians such low rates that they have reduced incentives to care for low-income patients.

Indeed, physician refusal to take Medicaid patients is one of Speaker Ryan’s central criticisms of Medicaid.

What about the effects of a block grant system on federal funding of health care?

Once block funding was initiated in 1977, health care funding became a line item in the federal budget that could be arbitrarily cut or capped for fiscal or political reasons, as opposed to a level of spending pegged to the needs and health care use of the population. Importantly, these cuts occurred under both conservative and liberal federal governments.

When the Canadian health transfer began, the federal government paid 50% of provincial costs. However, the transfer has steadily declined, until it is now about 20%. Sommers and Naylor predict that US federal block grants would also decline, and this is clearly one of Speaker Ryan’s goals.

However, Canadian health care spending per capita has not declined.

As the cost of providing care has risen, but the federal health transfer has stayed fixed or declined, the provinces have taxed more and the federal government has taxed less. The provincial governments hate this, because they would rather have the federal government make the unpopular choice to raise taxes. But it’s not clear whether block granting has made a big difference in the health care received by Canadians.

American states could similarly increase taxes in response to a declining federal Medicaid block grant, but would they? The key difference between Canadian public health insurance and Medicaid is that the former is universal, while the latter is means-tested. Ontarians prefer lower taxes, but if Ontario decreases funding for OHIP, every Ontarian will experience longer waits for care. But American states can cut Medicaid — and reduce taxes — without affecting the health care of better off and able-bodied citizens.

The affluent and able-bodied are also the citizens most likely to vote. American states determine their own voting procedures. Block granting gives states an incentive to manage voting so as to reduce the participation of the marginalized communities who are most in need of public health insurance. Block granting is likely to undermine the health care for the poor and disabled, and it could reinforce the post-Shelby County v. Holder efforts to restrict voting.

 

Per Capita Caps in Medicaid — Lessons from the Past

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http://www.nejm.org/doi/full/10.1056/NEJMp1615696?query=featured_home&

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Medicaid’s introduction also generated large benefits. Medicaid reduced mortality among infants and children, provided financial protection for their families, and led to better health, higher employment, and lower use of public benefits when they grew up. Moreover, by increasing tax revenue and reducing cash transfers, Medicaid currently saves federal and state governments $21 billion per year.5

How do these historical policies compare with today’s Medicaid-reform proposals? Ryan’s proposed caps apply only to Medicaid spending and recipients, since Medicaid was long ago decoupled from cash welfare. The cap amounts would initially equal average 2016 Medicaid spending by eligibility category and by state, rather than a single statutorily defined amount. Yet the caps would be “set to grow more slowly than under current law,” so over time they cease being related to actual Medicaid costs, thereby limiting the ability of states to adjust to rapid advances in technology, epidemics, or other unforeseen events. Nevertheless, as in the 1950s, discouraging Medicaid recipients from receiving costly care or keeping the highest-cost patients out of the program would be the clearest ways to limit state outlays. Toward that end, the Ryan plan would allow states to impose work requirements, charge premiums, offer a limited benefit package, shift beneficiaries into the individual insurance market, and create enrollment caps or waiting lists.

Medicaid creates a divisive relationship between the federal and state governments. Federal mandates and open-ended federal cost sharing are meant to provide incentives for state spending, but states often balk at the large costs. Both state and federal budgets would benefit if each Medicaid recipient cost less. Unfortunately, a per capita cap on federal Medicaid spending is unlikely to achieve this aim. Rather than “modernize” Medicaid, the historical experience in the United States suggests per capita caps would simply shrink the program.

 

What Does The House Health Care Bill Mean For California?

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http://californiahealthline.org/news/what-does-the-house-health-care-bill-mean-for-california/?utm_campaign=CHL%3A%20Daily%20Edition&utm_source=hs_email&utm_medium=email&utm_content=45683230&_hsenc=p2ANqtz-8hQ_w4Pw5zHW51oLQoG_Xu0Ms93jCK5wrfNop7LshVTnlXB2FBzI2QEr6vrjLhLuv48jwJS8sMDL_9vbf-OT9Z2EdBlg&_hsmi=45683230

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As the most populous state with the largest economy in the country, California stands to be dramatically affected by changes to the nation’s health law.

About 1.5 million people buy health insurance through the state’s exchange, Covered California, and most get federal subsidies. About 4 million receive Medicaid (called Medi-Cal here) through the program’s expansion under the Affordable Care Act. Altogether, Medi-Cal covers 14 million people in the state, roughly a third of its population.

The current House bill proposes to significantly change how — and how much — the federal government pays for these programs.

A Congressional Budget Office analysis released Monday found that, if passed, the bill could leave 24 million people uninsured by 2026, while saving the federal government $337 billion. Some Republican leaders contested those estimates, although House Speaker Paul Ryan said he was encouraged by the potential drop in costs.

That likely would translate into millions of people in California losing coverage or seeing their costs rise. Medi-Cal might have to cut programs and eligibility.

On Tuesday, California health care reporter Stephanie O’Neill discussed the potential effects of the bill on California residents with NPR “Morning Edition” host Rachel Martin.

Trump Outlines 5 Principles for Healthcare Reform

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http://www.healthcaredive.com/news/trump-outlines-5-principles-for-healthcare-reform/437171/

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Medicaid’s Role: What’s at Stake Under a Block Grant or Per Capita Cap?

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Medicaid’s Role: What’s at Stake Under a Block Grant or Per Capita Cap?

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A new video slideshow from the Kaiser Family Foundation explains how Medicaid works now and what is at stake as policymakers in Washington consider converting program financing to a block grant or per capita cap.

The 3-minute video describes how Medicaid is financed under current law, whom it covers and how spending is distributed across various groups of enrollees, including children, adults, seniors, and people with disabilities. It shows, for instance, that although seniors and people with disabilities comprise about a quarter of Medicaid enrollees, they account for nearly two-thirds of Medicaid spending because they have more complex health needs and therefore higher per person costs.

Proposals to convert Medicaid to a block grant or per capita cap financing could reduce federal Medicaid spending over time and be tied to increased flexibility for states in how they run their Medicaid programs. However, the video slideshow also explains how such proposals may shift costs to states, beneficiaries and providers, as well as limit states’ ability to respond to changes in medical costs and/or demand for Medicaid.

PD Editorial: 20 million reasons to retain and repair Obamacare

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http://www.pressdemocrat.com/opinion/6701027-181/pd-editorial-20-million-reasons

For six years, and over the course of five dozen high-profile, low-probability votes, Republicans in Congress vowed to do away with Obamacare.

Republicans denounced the Affordable Care Act as “a crime against democracy” and labeled it “the most dangerous piece of legislation ever passed.” Oklahoma Sen. Tom Coburn went so far as to warn seniors, “You’re gonna die sooner.”

The election of Donald Trump removed the specter of a presidential veto, yet the Affordable Care Act hasn’t been repealed.

Large and boisterous crowds supporting Obamacare at town hall meetings probably are making some lawmakers nervous about the fallout from killing a program that provides insurance for 20 million Americans. Here’s another possible explanation: Despite its shortcomings, Obamacare has delivered on its basic promise — expanding access to health care by reducing the cost of insurance, especially in states such as California that fully embraced the program.

California has reduced its uninsured rate to a record low of 7.1 percent, according to a report issued this month by the Centers for Disease Control and Prevention.

That’s a decline of 9.9 percentage points since the Affordable Care Act took full effect in 2013.

The CDC figures, based on data for the first three quarters of 2016, also showed a marked improvement on a national scale, with 8.8 percent of Americans lacking health insurance. In 2013, the uninsured rate was 14.4 percent.

Let those be benchmarks.

Trump and congressional Republicans still say they’re going to repeal and replace the Affordable Care Act. But any plan that results in fewer people having coverage isn’t a replacement. It’s retrenchment. And that isn’t acceptable.

Despite their harsh criticism of Obamacare, Republicans are far from agreeing on any replacement. They have promised to keep the most popular provisions of Obamacare, including protection for people with pre-existing conditions and coverage of dependents up to age 26. There also is GOP support for retaining requirements that insurers cover treatment of mental illness and substance abuse. Targeted for elimination are the financing mechanisms needed for the program to remain viable — individual and employer mandates and subsidies to help low- and middle-income families pay insurance premiums. A proposal to convert Medicaid to a block grant program almost certainly will result in some states raising the threshold for eligibility.

The numbers simply don’t add up.

Hospitals justifiably fear a return to the days of writing off millions of dollars from providing emergency care to uninsured patients, and insurers will have little choice but to drop out of the exchanges — 11 participate in California — if people can wait until they’re sick before buying coverage.

That’s the death spiral Republicans have been predicting since the Affordable Care Act passed in 2010. It could become a self-fulfilling prophesy if insurers conclude that the risk pool that undergirds the insurance market has been, or will soon be, undermined.

No big program is perfect. Republicans have pointed out Obamacare’s shortcomings for years while refusing to work with Democrats on improvements. If it collapses now, some Republicans will point fingers at Obama and claim the program was fatally flawed. But if millions of people who gained access to health insurance suddenly find themselves without coverage once again, many of them are going to blame the people who wrote the cancellation notice.