Tag Archives: Medicaid

Medicaid’s Role in Financing Behavioral Health Services for Low-Income Individuals

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Medicaid’s Role in Financing Behavioral Health Services for Low-Income Individuals

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Behavioral health conditions affect a substantial number of people in the U.S. and are especially common among people with low incomes.1,2,3 Behavioral health conditions include mental illnesses, such as anxiety disorders, major depression, bipolar disorder, schizophrenia, and post-traumatic stress disorder, as well as substance use disorders (SUD), such as opioid addiction. These conditions range in severity, with some being more disabling than others.  People with behavioral health needs may require a range of services, from outpatient counseling or prescription drugs to inpatient treatment.

As a major source of insurance coverage for low-income Americans, and as the only source of funding for some specialized behavioral health services, Medicaid plays a key role in covering and financing behavioral health care. In 2015, Medicaid covered 21% of adults with mental illness, 26% of adults with serious mental illness (SMI), and 17% of adults with SUD.4 In comparison, Medicaid covered 14% of the general adult population.5 In total, approximately 9.1 million adults with Medicaid had a mental illness and over 3 million had an SUD in 2015. Nearly 1.8 million of these adults had both a mental illness and an SUD.6,7

Current Medicaid program financing guarantees federal financial support to states with no pre-set limit. The Better Care Reconciliation Act (BCRA), as proposed by the Senate, restructures federal Medicaid financing by changing it to a per capita cap or block grant, which would likely impact states’ ability to provide coverage for and access to behavioral health services for people who need them. This issue brief provides an overview of Medicaid’s role for people with behavioral health needs, including eligibility, benefits, service delivery, access to care, spending, and the potential implications of the BCRA.

Healthcare CEOs: Senate healthcare bill would have dire consequences

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http://www.healthcarefinancenews.com/news/healthcare-ceos-senate-healthcare-bill-would-have-dire-consequences?mkt_tok=eyJpIjoiWkRZMVlqUTNZVE13WVRreCIsInQiOiJEOTJKXC9BRnluY1JjdkVVc0kwSlhFMGx5dmc4cnpDeW1GZGtsT25WOUFiSFdSeDdtYW1yNmRoQ2NQZk1vMnZheXJRUkQ3bW0xZzVNbkR4ZXBKNEFqR3ZOWCtYMFAwb3dlckZjVlFxc2tlWFJpYUY0SnIwc0doRVJYUFpSTkc4SEkifQ%3D%3D

Cleveland Clinic, Kaiser, NewYork-Presbyterian executives are all concerned over the Senate’s bill.

Healthcare CEOs made the rounds of news shows in this week to air their grievances with the Better Care Reconciliation Act, the Senate GOP bill intended to replace Obamacare.

The American Hospital Association, American Medical Association, AARP, and several other organizations have registered their opposition to the proposed bill.

But, it’s healthcare CEOs who are working to mitigate the anticipated changes who are anticipating how the proposed legislation would affect their organizations.

Among healthcare chief executives weighing in on the topic in recent days are Cleveland Clinic CEO Toby Cosgrove, MD, New York Presbyterian CEO Steven J. Corwin, MD, and Kaiser Permanente CEO Bernard Tyson.

Cleveland Clinic CEO Toby Cosgrove

With the anticipated greater numbers of uninsured patients coming into hospitals, “you’re going to have hospitals that are in very deep financial trouble,” Cosgrove told CNBC’s “Squawk Box” on Wednesday. “And this is particularly true of rural hospitals and safety net hospitals, which are very dependent on Medicare and Medicaid for their returns.”

As he sees it, legislators are not looking at the “root cause of the problem.” It’s not how you divide the money,” he said. “The problem really is the rising cost of healthcare.”

“I think if we came together and dealt with the root cause there’d be plenty of money to go around to look after people,” Cosgrove said. “But if we don’t deal with it now, we’re going to have the same problem going 10 years from now.”

“We’re really headed in the wrong direction,” Cosgrove said. We’re talking about payment reform; we’re not talking healthcare reform.”

Kaiser Permanente CEO Bernard J. Tyson

Bernard J. Tyson, chairman and CEO of Oakland, Calif.-based Kaiser Permanente, wrote in a LinkedIn post that although the ACA – also known as Obamacare – is an imperfect legislation, future healthcare reform must build on its progress, rather than undo it.

“We need to pause and ask policymakers to answer the most fundamental question: What does progress on healthcare look like for the people in America?”

In his view, it should cover more people, not fewer people; be affordable.

Without question, we must make healthcare more affordable; provide the best quality of care and best health outcomes.

Tyson points out that the U.S. has among the poorest health outcomes compared to the other developed nations. The healthcare industry can improve quality if “we commit to moving from a predominantly ‘sick care,’ episodic, fee-for-service model to a predominantly preventive model with incentives for value, integrated care and, most important, keeping people healthy.”

“The draft bill does not expand coverage; it does not do enough to protect people in need of care, nor does it provide enough assistance to those who need help in paying for health care and coverage,” he writes.

NewYork-Presbyterian CEO Steven J. Corwin

Speaking to Bloomberg on Tuesday, Steven J. Corwin, CEO of NewYork-Presbyterian said, “Just remember this: One in three children in this country is insured by Medicaid. One in three.”

Corbin noted that two-thirds of the expense of Medicaid are for people who are in nursing homes.

“So, you can work all your life, be a grandma, or ma, and then go through your assets, and then you have to be on Medicaid to go into a nursing home,” he said. “This is going to be devastating to so many people.”

Asked whether he would prefer having something concrete done in Congress or just see the proposed bill go away, Corbin said: “I’d like to see it go away. And, I’d like to see the Medicaid expansion remain, and I’d like to see the insurance market stabilized.”

 

What a Trump Presidency Means for Value-Based Care and the ACA

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https://revcycleintelligence.com/features/what-a-trump-presidency-means-for-value-based-care-and-the-aca?elqTrackId=b434f9c1bb9342b9a07ae438e60e0219&elq=235b6caa09e94e4eb4db871c5d4f6292&elqaid=2897&elqat=1&elqCampaignId=2683

 

The future of the Affordable Care Act is up for debate after Donald Trump’s surprise victory, but value-based care is likely to remain a guiding force in the healthcare industry.

Love it or loathe it, the United States is headed for four years of drastic policy changes under a Donald Trump administration, giving lawmakers another good chance to repeal, replace, or revise the Affordable Care Act.

The landmark healthcare legislation was the centerpiece of one of the most contentious campaigns in American history.  Staring down anticipated premium hikes of up to 25 percent on the public health insurance exchanges, millions of concerned citizens voted for the candidate they felt was most likely to make positive changes to a system that has never quite managed to address their needs.

The impact of a Republican Congressional majority, a Republican President, and a vacant seat on a Supreme Court that already struck down one of the ACA’s major provisions is as of yet unknown, but a conservative twist to our national drama will certainly bring the future of the healthcare coverage framework into question.

For healthcare provider organizations, the plot will thicken even further.  Thanks to provisions that require payers to cover patients with preexisting conditions and adhere to premium caps that have reduced their profitability, the ACA has incentivized a quick shift towards value-based care.

Eager to trim costs, pay for fewer services, and attract as many patients as possible in a competitive and confusing marketplace, payers have incentivized providers to abandon the traditional fee-for-service reimbursement structure and look to population health management strategies as a way to stem the financial bleeding.

Will significant changes to the Affordable Care Act free up payers to return to more lucrative business practices, or will commercial insurers, Medicare, and Medicaid stay the course?

How can healthcare providers position themselves for success in what will undoubtedly be another turbulent episode in the healthcare saga, and what are the nation’s options for developing a new path forward while still delivering the best possible care to its patients?

Hospitals Attack GOP Health Bill in $1 Million Ad Campaign

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https://www.bloomberg.com/news/articles/2017-06-27/hospitals-attack-gop-health-bill-in-1-million-new-ad-campaign

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Powerful hospital and medical school lobbying groups are spending at least $1 million on television ads opposing Senate Republicans’ plan to repeal and replace Obamacare.

The ads ask viewers to consider whether they’ll be among the millions of Americans projected to lose their health coverage under the Senate proposal, Rick Pollack, chief executive officer of the American Hospital Association, said Tuesday in a conference call with reporters.

The bill, which Republicans have put on hold until after the July 4 recess amid growing opposition within their own party, would leave an additional 22 million people in the U.S. without insurance, the non-partisan Congressional Budget Office estimated. Hospitals have a lot to lose under the current version of the bill, and the AHA, which represents about 5,000 institutions, last week told GOP senators to “go back to the drawing board.”

It’s the second time that the coalition will run ads opposing Republicans’ attempts to replace the Affordable Care Act, often called Obamacare. The group also ran ads opposing the House’s health bill, which passed in May. The House proposal would also increase the number of uninsured by more than 20 million, according to the CBO.

Samantha Dean, a spokeswoman for the AHA, said the campaign’s ads have already begun running and will cost seven figures. She wouldn’t give a precise amount.

The advertisements will continue to run “for as long as needed,” Dean said.

Analysis: Mitch McConnell Plans To Hide Trumpcare’s Pain Until After Midterms

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http://www.healthleadersmedia.com/technology/analysis-mitch-mcconnell-plans-hide-trumpcare%E2%80%99s-pain-until-after-midterms?spMailingID=11361778&spUserID=MTY3ODg4NTg1MzQ4S0&spJobID=1182449350&spReportId=MTE4MjQ0OTM1MAS2

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The Better Care Reconciliation Act bill may make the health insurance markets look better almost immediately by giving insurers a more predictable, more lucrative market.

Senate Majority Leader Mitch McConnell is well aware of the political peril of taking health benefits away from millions of voters. He also knows the danger of reneging on the pledge that helped make him the majority leader: to repeal Obamacare.

Caught between those competing realities, McConnell’s bill offers a solution: go ahead and repeal Obamacare, but hide the pain for as long as possible. Some of the messaging on the bill seems nonsensical (see: the contention that $772 billion squeezed out of Medicaid isn’t a cut). But McConnell’s timetable makes perfect sense — if you are looking at the electoral calendar.

Here are a few key dates in McConnell’s “Better Care Reconciliation Act” (BCRA) that seem aimed more at providing cover for lawmakers than coverage for Americans:

2019: First major changes and cuts to the Affordable Care Act exchanges happen after the 2018 midterm cycle, allowing congressional Republicans to campaign on a “fixed” health system, even though Obamacare is still largely in place next year.

2019: States share $2 billion in grants to apply for waivers under a much looser process through this fiscal year. These waivers could allow insurers to sell skimpy plans that have low price tags but don’t take adequate care of people with preexisting conditions. None of those waivers has to go into effect, however, until after 26 Republican governors face re-election in 2018.

2020: Stabilization cash that makes the markets more predictable and fair for insurers flows through the congressional midterm cycle and the 2020 presidential cycle. Then it disappears. Medicaid expansion funds hold steady through this crucial political window, too.

2024: States enjoy their last few sips of Medicaid expansion cash at the end of 2023 — just as, perhaps, a second Republican presidential term is ending.

2025: The bill changes the formula for the entire Medicaid budget (not just the Obamacare expansion), dramatically reducing federal funding over time. That starts eight years and two presidential election cycles from now.

McConnell insists everything about the bill has been aboveboard and transparent.

“Nobody’s hiding the ball here. You’re free to ask anybody anything,” McConnell said on June 13.

But he and his working group did literally hide the bill from Democrats and most Republicans, crafting it behind closed doors until there was just a week left before his goal to secure a vote on it. (That timing was thrown off Tuesday with the announcement the vote was delayed, but the dealmaking is just beginning.)

Meanwhile, at least two policy details in the bill may obscure the effects for several years and make the health insurance markets look better almost immediately by giving insurers a more predictable, more lucrative market.

One is a stipulation that compels the federal government, for two years, to pay the cost-sharing reduction payments to insurance companies that President Donald Trump has threatened to end. The payments are part of the Affordable Care Act, and they flow to insurers on behalf of low-income marketplace customers to cover their out-of-pocket health expenses. Republicans had sued to stop the payments, adding considerable instability to ACA marketplaces next year. McConnell ends that uncertainty for two years.

On top of that cash infusion, the BCRA proposes a “Short-Term Stabilization Fund” that would also aim to help lower premium costs and could attract a few more insurers into counties that are sparsely covered now. It would dish out $50 billion to insurers — $15 billion per year in 2018 and 2019 and $10 billion per year in 2020 and 2021.

 

 

 

 

Medicaid, a “broken program that harms its beneficiaries”

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Medicaid, a “broken program that harms its beneficiaries”

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I asked on Twitter for policymakers’ expressions of harm caused by Medicaid.

Austin Frakt 

✔@afrakt

Seen a *policymaker* justify BCRA Medicaid changes because “Medicaid causes harm”? Send me the link. cc @aaronecarroll

By email, Andrew Goodman-Bacon came through in a huge way. The bullets below are a lightly edited version of what he sent me, shared with his permission. (For the record, Medicaid does not cause harm. More about that soon.)

  • The Sommers/Epstein paper surveyed governors and found that five of those who opposed expansion felt that Medicaid was a “broken program that harms its beneficiaries.”
  • Senator Ted Cruz has said that Medicaid hurts health care access
  • In one of Tom Price’s recent testimonies he said ,“Medicaid is a program that has, by and large, decreased people’s ability to access care.”
  • Speaker Paul Ryan comes close on pg 24 of “A Better Way
  • A Healthy Indiana report (notably produced by the Pence administration) cites Roy and LaPar, but doesn’t go all in on the “harms” claim
  • Here is the American Action Forum saying “harm”
  • See also, this brief from a policy shop in MI, this brief from a policy shop in NC, and this brief from a policy shop in PA
  • Here is ALEC citing that study, although not going so far as to say patients will be “harmed”

To these, I will add this quote of Representative Bill Cassidy (via Aaron) and this op-ed by Seema Verma (via Adrianna). Note: I have not looked through everything in the above list. If you find errors or have more contributions, let me know.

Medicaid: Welfare or Health Insurance?

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https://www.axios.com/the-great-medicaid-divide-2445011303.html

Image result for Republicans see Medicaid as welfare. Most Americans don't

Republicans want to roll back the Medicaid expansion, cap federal Medicaid spending increases, and add work requirements, drug testing, time limits, copays and premiums to some state Medicaid programs. But almost no one else wants to do these things. One poll finding goes a long way toward explaining why: Republicans view Medicaid as a form of welfare, and pretty much everyone else views it as a government insurance program.

Why it matters: Welfare remains unpopular in our country; it’s always popular to limit or cut “welfare”. Whether it should be, and what this says about us, is a different question.

What the poll found: As the chart shows, Democrats (73%) and independents (62%) view Medicaid as an insurance program similar to others that help people pay for health care. But a slight majority of Republicans (52%), see it as more similar to welfare programs like food stamps.

Between the lines: One reason Medicaid limits are no slam dunk for Republicans in the Senate may be that not all Republicans view it as welfare: 46% see it as insurance, just as most Democrats and Independents do. Republicans who are more moderate are worried about the practical effects on citizens and states of rolling back the expansion or cutting federal Medicaid spending. One assumes they wouldn’t worry as much unless they viewed Medicaid as valuable health insurance coverage.

Perceptions of Medicaid as welfare don’t seem bothered much by facts, such as, for example, that two thirds of Medicaid spending goes for the low income elderly and disabled who don’t fit the Ronald Reagan era image of the welfare king or queen. But it’s not the majority view in any case. A little less than a third of voters identify as Republicans today, and about half of them see Medicaid as welfare.

It’s this group and their perceptions of the program, and elected officials who share their views, that seem to be driving debate about Medicaid today.

Explaining Medicaid’s Starring Role in the U.S. Health Debate

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https://www.bloomberg.com/news/articles/2017-06-27/medicaid-s-starring-role-in-u-s-health-care-flap-quicktake-q-a

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The biggest single change called for by the Republican health-care bill that may be voted on by the U.S. Senate this week is its reduction in federal spending on Medicaid, the program for poor and disabled Americans. The bill is being championed by Majority Leader Mitch McConnell and backed by U.S. President Donald Trump as a way to “repeal and replace” the Affordable Care Act, also known as Obamacare. The Senate bill, like one passed in May by the House of Representatives, would roll back Obamacare’s expansion of Medicaid and make other far-reaching changes to the program as well.

1. Who does Medicaid serve?

It’s the biggest health insurer in the U.S., providing benefits to about one in fourAmericans. It covers almost half of all births, almost two-thirds of people in nursing homes, almost 40 percent of all children and almost a third of adults with disabilities. Total Medicaid spending was $552 billion in the 2015 fiscal year, 17 percent of overall health spending. Along with education, Medicaid is one of the two largest components of spending by state governments, which administer the program and fund it in partnership with the federal government.

2. How did Obamacare change Medicaid?

It expanded Medicaid to cover those who were unable to afford private insurance but didn’t have incomes low enough to qualify for Medicaid before. After a Supreme Court ruling made the expansion optional, 31 states and the District of Columbia used the financial incentives offered under the Obamacare law to add about 12 million people to the Medicaid rolls. To congressional Republicans’ ire, the expansion was funded in part by tax increases on higher-income people. The federal government pays more than 90 percent of the cost of the Medicaid expansion.

Reverse the expansion of Medicaid, at different paces. The House bill would wind down funding for the expansion starting in 2020. The Senate bill would phase out the expansion’s funding between 2021 and 2024.

4. How else would they change Medicaid?

Currently, the federal government generally reimburses states for a fixed percentage of Medicaid expenditures, regardless of total spending or number of people enrolled. The Republican bills would impose a per-person limit on Medicaid reimbursement that would increase over time at a rate linked to inflation. The Congressional Budget Office said that under the House bill, which uses the rate of medical inflation to set the pace of spending, federal Medicaid spending would decrease by $834 billion between 2017 and 2026. The Senate bill would set a lower growth rate starting in 2025 by using the general inflation rate as a benchmark for much of Medicaid’s spending, rather than the medical inflation rate.

5. What would the impact be?

The Congressional Budget Office estimates that between 2017 and 2026, 15 million fewer people would be covered by Medicaid under the Senate bill, and 14 million fewer under the House bill, than under Obamacare. In both cases, Medicaid would account for about two-thirds of the increase in the number of uninsured projected by the CBO.

6. How else could poor people get coverage?

The House and Senate bills would make them eligible for subsidies for individual insurance policies, meaning people who are dropped from Medicaid could use the subsidies to buy their own coverage. Critics say the bill would make those policies unaffordable to low-income people by increasing deductibles.

7. What’s the debate about the bills like?

8. What’s Trump’s position?

During the 2016 campaign, Trump said that unlike other Republican candidates he would not cut Medicaid, Medicare or Social Security. But he did support the House health-care bill. After McConnell introduced a draft version of his bill, Sean Spicer, the White House spokesman, said that Trump was “very supportive” of the bill but was “committed” to making sure that people currently on Medicaid didn’t lose their coverage.