Tag Archives: Medicaid Expansion

Indiana, Pence’s Home State, Seeks Federal OK To Keep Medicaid Expansion

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http://khn.org/news/indiana-pences-home-state-seeks-federal-ok-to-keep-medicaid-expansion/

Statehouse of Indiana in Indianapolis (iStock/Getty Images Plus)

As Congress weighs repeal of the Affordable Care Act, the home state of Vice President Mike Pence Tuesday sought to keep its conservative-style Medicaid expansion under the federal health law.

Indiana applied to the Trump administration to extend a regulatory waiver and funding until Jan. 31, 2021, for its innovative package of incentives and penalties that are intended to encourage low-income Hoosiers on Medicaid to adopt healthy behaviors. Beneficiaries pay premiums, get health savings accounts and can lose their benefits if they miss payments.

Though Pence now supports the health law’s repeal, the Healthy Indiana Plan that he established in 2015 as the state’s governor has brought Medicaid coverage to more than 350,000 people. The architect of the plan was health care consultant Seema Verma, who has been nominated to head the Centers for Medicare & Medicaid Services.

Without Trump administration approval, federal money for Indiana’s expansion will run out Jan. 31, 2018. Indiana officials said the Medicaid expansion would continue even if Washington follows through on a Republican proposal to distribute federal Medicaid funds through a block grant program that would give states more flexibility in setting benefits and eligibility levels.

State officials refused to say whether the expansion would continue if Congress repealed Obamacare and eliminated funds for Medicaid expansions. If that happened, it’s unlikely states would have the money to make up for the lost federal aid.

Indiana’s effort to continue its Medicaid expansion demonstrates how states that expanded Medicaid under the Affordable Care Act — even Republican-controlled ones — are counting on additional federal dollars to pay for those expansions. It also reflects deadline pressure: They can’t wait for Congress to finish its debate over the future of the health law because they need to set budgets and programs now for next year.

According to Indiana’s request, continuing the Medicaid expansion will cost Indiana $1.5 billion but bring $8.6 billion in federal funding from 2018 to 2020.

“Indiana has built a program that is delivering real results in a responsible, efficient, and effective way,” Gov. Eric Holcomb, a Republican, said in a statement. “I look forward to maintaining the flexibility to grow this remarkably successful tool and to preserve our ability to respond to the unique needs of Hoosiers.”

Several other states including Kentucky and Ohio are considering adopting features of Indiana’s Medicaid plan.

 

Rolling Back the ACA’s Medicaid Expansion: What Are the Costs for States?

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http://www.commonwealthfund.org/publications/blog/2017/feb/states-roll-back-aca-medicaid-expansion

Millions of people have gained health insurance coverage though the Affordable Care Act’s (ACA) Medicaid eligibility expansion, adopted by 31 states and Washington, D.C., over the past three years. Should Congress decide to eliminate or reduce federal funding for this coverage as part of ACA repeal, states that expanded will be faced with the prospect of either maintaining coverage out of their own funds or dropping the new beneficiaries from the program. Along with the loss of coverage or the creation of large budget holes, rolling back Medicaid benefits would present states with expensive and complex administrative challenges.

Were Congress to repeal federal funding for the expansion group, coverage for these newly eligible enrollees—estimated at 11 million as of 2015—inevitably would disappear. No state is in a position to support this population without considerable federal funding. For example, were ACA Medicaid expansion funding to disappear, California would lose more than 27 percent of the total federal Medicaid funding the state is projected to receive over the 2019 to 2028 time period; federal funding would drop from $364 billion to $265 billion, a $99 billion loss.

If a repeal bill retains the Medicaid expansion but reduces federal funding for the expansion group to traditional Medicaid funding levels,1  some states might seek flexibility to roll back coverage to a lower level such as 75 percent of poverty, rather than the eligibility standard used under the expansion (138 percent of poverty). Rather than terminate insurance eligibility altogether for populations without an alternative source of coverage, states also might try to trim benefits or reduce or freeze provider payments.

But even if funding is eliminated completely, federal laws place important brakes on the process. For example, federal Medicaid rules dating back decades require states to determine if there is another basis of eligibility prior to terminating coverage. At least some of the people covered as part of the expansion population may qualify for Medicaid on other grounds such as pregnancy, being the parent of a minor child, or disability.

Covering the Coming Battle Over the ACA: What You Need to Know

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Click to access PDF%20WebinarBattleOverACA12192016Adams.pdf

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Click to access PDF%20WebinarBattleOverACAResources.pdf

 

Hospital leaders support keeping many elements of ACA

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http://www.revenuecycleinsights.com/news/hospital-leaders-support-keeping-many-elements-aca?mkt_tok=eyJpIjoiWWpCaU1USXhZbVEzWkRCaiIsInQiOiJURzlCeG5tb05KNjN5QU9UMGIrVFBoZkxiS3Q2WHdPZDZRNXJ0TFQzemdXdVwvS3pPa3UrcWNOQTVxanpaVW5mMFFoUzk4OXc0ejg2dSs2SkRGWHErZDlqUjlhd1dTQit3c2VBaXdGSDdPK1IzQXEwdWNNaWt6YjFRQ2xyR3JZNloifQ%3D%3D

An overwhelming majority of hospital C-suite and pharmacy executives support preserving the protections in the Affordable Care Act (ACA) for patients with preexisting conditions, according to a post-election survey.

Member-based healthcare performance improvement company Vizient conducted the survey to assess how member hospitals were reacting to the planned repeal of the ACA by the Trump administration and Republican leaders in Congress. Vizient also asked executives about their top concerns for the future as well as their priorities for 2017.

Nearly 90 percent of C-suite leaders (89.5 percent) and 96 percent of hospital pharmacy executives surveyed said the ACA’s protections for patients with preexisting conditions should be kept in place.

Other findings from the survey show:

  • 68 percent of hospital C-suite leaders and 35 percent of hospital pharmacy executives want to keep incentives for expanding Medicaid coverage
  • 56 percent of hospital executives and 46 percent of hospital pharmacy leaders want to continue subsidies to help consumers pay for insurance
  • 52 percent of hospital C-suite leaders and 39 percent of pharmacy executives want to continue value-based reimbursements.

The top three priorities for all executives this year were 1) reducing clinical variation across care delivery 2) migrating toward value-based models, and 3) the integration of existing technology systems, Vizient said.

“In reviewing the survey results, central themes come through: uncertainty and concerns about financial viability,” Byron Jobe, president and chief administrative officer for Vizient, said in a statement. “There are many open questions about the future of the ACA, and what a repeal and replacement strategy could look like. As Congress wrestles with these decisions, it’s important to ensure reimbursement levels are enough to allow hospitals to continue their mission of caring for patients in their communities. Equally important, hospitals must quickly gain a clear understanding of where health policy is heading so they can begin to prepare.”

More families with employer-sponsored insurance are needing public assistance

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http://www.academyhealth.org/blog/2017-01/more-families-employer-sponsored-insurance-are-needing-public-assistance

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As employer-sponsored insurance becomes more expensive for children, public programs are picking up the slack.

The Medicaid Expansion, which was responsible for a large part of the reduction in uninsurance in the United States over the last few years, was mostly aimed at adults. This is because Medicaid has traditionally covered nearly all children in poverty for some time. The CHIP program has bolstered that coverage, so that uninsurance in children fell steadily in the 1990’s and well into the 21st century.

The passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) assured that CHIP coverage would continue for some time. But even before that, trouble was brewing with respect to the coverage of children. These troubles were not in the Medicaid  program, though. Issues were arising in the employer-sponsored insurance market.

As I’ve written about in many posts here before, the cost of employer-sponsored insurance has been rising quite steadily for some time. Further, the out-of-pocket costs for such insurance have also been increasing. Deductibles, co-pays, and co-insurance – not to mention premiums – can put the cost of insurance out of reach for many employees even when it is “offered” as a benefit from their job. The costs of insurance have outpaced both income and wages for more than a decade, meaning that more and more must come out of employee’s pockets if they want to maintain coverage for themselves and their children.

 

Medicaid Financing: The Basics

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http://kff.org/report-section/medicaid-financing-the-basics-issue-brief/

Figure 1: Medicaid costs are shared by the states and the federal government.

 

Republican governors have a stake in keeping the Medicaid expansion. Will congressional Republicans listen?

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https://www.brookings.edu/blog/fixgov/2017/01/24/medicaid-governors-and-congress/

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The House and Senate took the first steps two weeks ago towards an eventual repeal of parts of the Affordable Care Act (ACA). At the same time, significant uncertainty as to how efforts proceed from here remains. There are disagreements among congressional Republicans on virtually every component of a path forward, including a timeline, the connections between a repeal bill and an approach to replacement, and what, if any, components of the law should be preserved.

One important set of actors, however, has already begun to weigh in on the process: several of the nation’s Republican governors. In particular, a number—including Charlie Baker of Massachusetts, Rick Snyder of Michigan, John Kasich of Ohio, Asa Hutchinson of Arkansas, and Brian Sandoval of Nevada—have voiced concerns about eliminating the Medicaid expansion. Together, these governors—several of whom recently met with members of the Senate Finance Committee to discuss the law—lead roughly one third of the 16 states that chose to expand Medicaid and currently have Republican executives. According to new data from the Kaiser Family Foundation, they represent roughly 2.2 million individuals who enrolled in Medicaid in 2015 thanks to the ACA’s expansion, or roughly 6 percent of the total population in these states. (By comparison, the national average for states for which Kaiser was able to obtain data is roughly 7 percent of a state’s population.)

In the case of Medicaid, as political scientist Shanna Rose has demonstrated, Republican governors have a long history of taking a different tack than their national counterparts. One source of this state-level variation involves the ability of the Secretary of Health and Human Services to waive provisions of federal law, at a state’s request, to allow for Medicaid pilot, or demonstration, programs. Beginning in earnest during the Reagan administration and escalating in particular under Clinton, governors nationwide have experimented with service delivery through waivers. Some feared that this experimentation could lead to restricted access, but research by Frank Thompson and Courtney Burke finds that, pre-ACA, governors more often than not used section 1115 Medicaid waivers to expand access for low-income Americans. This historical trend has continued throughout the ACA era, as governors have bargained with the Obama administration to secure waivers that expand access to Medicaid in their states.

 

‘Not Turning Back’: California Governor Vows To Protect State’s Health Care

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http://khn.org/news/not-turning-back-california-governor-vows-to-protect-states-health-care/

Gov. Jerry Brown (Neon Tommy via flickr)

In an unusually impassioned speech, Gov. Jerry Brown vowed Tuesday to protect California’s health care gains under Obamacare against Republican attempts in Washington, D.C., to roll them back.

“More than any other state, California has embraced the Affordable Care Act,” Brown told state legislators and appointees in his annual State of the State address at California’s Capitol. “I intend to join with other Governors and Senators, and with you, to do everything we can to protect the health care of our people.”

Brown said California would not “turn back” on advances it’s made in health coverage under pressure from the new Republican administration in Washington. Under the new federal leadership, he said, the “future is uncertain and dangers abound.”

Health coverage for Californians under the Affordable Care Act “has come with tens of billions of dollars from the federal government,” said Brown. “Were any of that were to be taken away, our state budget would be directly affected, possibly even devastated.”

Leveraging an estimated nearly $20 billion federal money, health coverage has been extended to five million Californians under Obamacare, which includes federally subsidized private health plans and an expansion of eligibility for Medicaid, the program for low-income people — known in this state as Medi-Cal.

 

Governors voice Medicaid concerns to GOP lawmakers

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http://www.fiercehealthcare.com/payer/governors-voice-medicaid-concerns-to-gop-lawmakers?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiTkRGbE9XWTBNVGcwTUROaSIsInQiOiJOZEtcLzhSNHFcL3A2UGlyd2JIQWNwK2ZoRGpWcENHODJZQTlLQ1R1OVo0b3JvdUdSdkN0a0FyTzhIdHVnYVhCN0lxNHRQbW5ibEVVWjBiR0VPU2tFdXBCVmxSYWtWcWZJQ2dyOUxIRnBlNURrakpFXC93Y2xHS21RdGFybUtZZVJlViJ9

Capitol Hill

A group of governors met with congressional leaders on Thursday to express their mounting concerns about the consequences of an Affordable Care Act repeal—particularly for those who have benefited from Medicaid expansion.

The closed-door meeting included several Republican state leaders, who despite generally opposing the ACA have accepted federal funds to expand Medicaid eligibility and are wary of rolling back such coverage expansions.

Michigan Gov. Rick Snyder, for example, said after the meeting that the data show his state’s Healthy Michigan program “had a lot of success, both in terms of healthier behaviors and better outcomes helping people,” according to The Hill.

Ohio Gov. John Kasich, another Republican who attended the meeting, suggested that those who gained coverage under Medicaid expansion could instead be given either premium subsidies or tax credits to help them buy private health insurance, Reuters reports.

But Synder and Kasich have been among the more vocal governors in support of Medicaid expansion, with Kasich crediting the program for helping fund the fight against opioid abuse that is ravaging his state.

Hospitals in states that have chosen to expand Medicaid eligibility have seen reductions in their uncompensated care costs, leading some in the healthcare industry to worry about what will happen under an ACA repeal. In addition, 15.7 million more people now have Medicaid coverage than before the ACA’s major coverage provisions took effect.

ACA Changes Favored 2 to 1 by Healthcare Leaders Over Repeal and Replace

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http://www.healthleadersmedia.com/leadership/aca-changes-favored-2-1-healthcare-leaders-over-repeal-and-replace

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As the Trump administration officially begins later this week, a new HealthLeaders Media survey shows that healthcare industry leaders support changes to the existing law rather than replacing it. Two-thirds of respondents (66%) say the best option for the healthcare industry regarding the Patient Protection and Affordable Care Act is to make some changes but otherwise retain it.

At the opposite ends of the spectrum, 27% favor full repeal and replacement, while only 7% of respondents say keep it as it is, indicating the extent of dissatisfaction with the PPACA.

Interestingly, a greater share of health systems (78%) than hospitals (66%) and physician organizations (65%) favor making some changes to the PPACA.

On the other hand, a greater share of hospitals (28%) and physician organizations (27%) than health systems (17%) prefer full repeal and replacement. This is perhaps an indication that health systems are less able than other providers to accept full repeal and replacement because of their greater complexity as organizations.

Among the 66% of respondents who say that the best option for the PPACA is to make some changes, the top three changes they advocate are adding a public health insurance option (61%), eliminating the excise tax on high-cost employer health benefit plans (‘Cadillac tax’) (50%), and eliminating the individual mandate and noncompliance penalty (37%).

The two changes receiving the fewest responses are eliminating Medicaid expansion (10%) and abandoning the focus on value-based care and reimbursement (16%).