Tag Archives: Medicaid

California Employer Health Benefits: Prices Up, Coverage Down

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http://www.chcf.org/publications/2017/03/employer-health-benefits?_cldee=aGVucnlrb3R1bGFAeWFob28uY29t&recipientid=contact-58e265c0591ce51180f7c4346bac4b78-22293f7225824dd0a2a16e01c6e7b1e7&esid=7e382ea0-c114-e711-80fa-5065f38a19e1

Since 2000, the percentage of employers offering health benefits has declined in California and nationwide, although coverage rates among offering firms have remained stable. Only 55% of firms reported providing health insurance to employees in 2016, down from 69% in 2000. These findings underscore the important role that Medi-Cal and Covered California play in providing insurance to working Californians — coverage that could be negatively impacted if the Republicans repeal and replace the Affordable Care Act.

Nineteen percent of California firms reported that they increased cost sharing in the past year, and 27% of firms reported that they were very or somewhat likely to increase employees’ premium contribution in the next year. The prevalence of plans with large deductibles also continues to increase.

California Employer Health Benefits: Prices Up, Coverage Down presents data compiled from the 2016 California Employer Health Benefits Survey.

Other key findings include:

  • Health insurance premiums for family coverage grew by 5.6%. Family coverage premiums have seen a cumulative 234% increase since 2002, compared to a 40% increase in the overall inflation rate.
  • The average monthly health insurance premium, including the employer contribution, was $597 for single coverage and $1,634 for family coverage in California, and was significantly higher than the national average.
  • 41% of workers in small firms faced an annual deductible of at least $1,000 for single coverage, compared to 17% of workers in larger firms. The prevalence of these higher deductibles in small firms has increased substantially in the past five years.
  • Only one in four firms with many low-wage workers (those earning $23,000 or less) offered health coverage to employees in 2016.
  • In the past year, 24% of large firms extended eligibility for health benefits to workers not previously eligible.

The complete Almanac report, as well as past editions, is available under Document Downloads.

Insurance Coverage, Access to Care, and Medical Debt Since the ACA: A Look at California, Florida, New York, and Texas

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http://www.commonwealthfund.org/publications/issue-briefs/2017/mar/coverage-access-medical-debt-aca-california-florida-new-york-texas

Background

More than 30 million Americans now have health insurance under the provisions of the Affordable Care Act.1 These provisions include those that have allowed or encouraged people to enroll in coverage through expanded Medicaid eligibility, tax credits to help pay for premiums, state and federal outreach efforts, and consumer-friendly market regulations.2 A recent analysis found that the percentage of uninsured working-age adults dropped from 20 percent in 2010 to 12 percent in 2016.3

The law gives states flexibility in implementing provisions, including the choice of operating their own health insurance marketplace or leaving that task to the federal government. Moreover, in 2012, the U.S. Supreme Court gave states the option to decide whether or not to expand Medicaid eligibility to more lower-income adults. These choices, combined with each state’s unique demographics and history, have resulted in varying experiences among Americans. In this brief, we use data from the Commonwealth Fund Biennial Health Insurance Survey to examine differences in health insurance coverage, problems getting needed care because of costs, and medical bill and debt problems among 19-to-64-year-old adults in the nation’s four largest states: California, Florida, New York, and Texas.4

These states fall into two distinct categories. The first group, California and New York, both operate their own health insurance marketplaces and have expanded eligibility for Medicaid to adults with incomes at or below 138 percent of the federal poverty level—$16,394 for an individual or $33,534 for a family of four. Florida and Texas, the second group, are using the federal marketplace to enroll residents in health plans and have declined to expand Medicaid eligibility (Exhibit 1).

Conclusion

The Affordable Care Act has significantly affected health insurance coverage and access among U.S. adults. But the decisions made by state leaders in implementing federal policy, along with other state laws, have ongoing implications for their residents. California and New York began seeing declines in their adult uninsured rate earlier than other states because of such choices. California expanded eligibility for Medicaid even before 2014 by creating the Low Income Health Program, which provided coverage to adults with incomes less than 200 percent of poverty.20 New York expanded Medicaid eligibility to parents with incomes up to 150 percent of poverty and childless adults up to 100 percent of poverty starting in 2000.21 In addition, both states opted to establish their own marketplaces and have conducted expansive outreach campaigns to increase awareness of coverage options. Alternatively, Florida and Texas—although they have experienced robust enrollment in private plans through the federal health insurance marketplace—have not expanded Medicaid eligibility and have made less progress covering uninsured residents.

However, the variation in insured rates is not entirely the result of states’ decision. The ACA does not provide access to any new coverage options for undocumented immigrants. They are ineligible for Medicaid coverage and cannot purchase private plans through the marketplace, subsidized or unsubsidized. This is likely a contributing factor in Texas’s higher uninsured rate.

While expanded coverage is the necessary first step to improving timely access to care and reducing medical financial burdens among U.S. families, the quality and comprehensiveness of coverage across all sources of insurance—marketplace plans, individual market plans, employer-provided coverage, and Medicaid—also has a significant impact.

The gains documented in this survey and many other private and federal analyses indicate that the Affordable Care Act has been successful in insuring millions of Americans and enabling them to get health care they may not have been able to afford previously. Further expanding coverage and improving affordability should remain a priority. Alternatively, repealing the law without a replacement that is at least equally effective will risk reversing the substantial gains the nation has made.

 

In Health Bill’s Defeat, Medicaid Comes of Age

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When it was created more than a half century ago, Medicaid almost escaped notice.

Front-page stories hailed the bigger, more controversial part of the law that President Lyndon B. Johnson signed that July day in 1965 — health insurance for elderly people, or Medicare, which the American Medical Association had bitterly denounced as socialized medicine. The New York Times did not even mention Medicaid, conceived as a small program to cover poor people’s medical bills.

But over the past five decades, Medicaid has surpassed Medicare in the number of Americans it covers. It has grown gradually into a behemoth that provides for the medical needs of one in five Americans — 74 million people — starting for many in the womb, and for others, ending only when they go to their graves.

Medicaid, so central to the country’s health care system, also played a major, though far less appreciated, role in last week’s collapse of the Republican drive to repeal and replace the Affordable Care Act, also known as Obamacare. While President Trump and others largely blamed the conservative Freedom Caucus for that failure, the objections of moderate Republicans to the deep cuts in Medicaid also helped doom the Republican bill.

“I was not willing to gamble with the care of my constituents with this huge unknown,” said Representative Frank A. LoBiondo of New Jersey, a member of the centrist Tuesday Group caucus, noting that in three of the counties in his district in the state’s more conservative southern half, over 30 percent of all residents are covered by Medicaid.

In the Senate, many Republicans, echoing their states’ governors, had worried about jeopardizing the treatment of people addicted to opioids, depriving the working poor, children and people with disabilities of health care and in the long run reducing funding for the care of elderly people in nursing homes.

The Republican bill would have largely undone the expansion of Medicaid under the A.C.A., which added 11 million low-income adults to the program and guaranteed the federal government would cover almost all of their costs. It would have also ended the federal government’s open-ended commitment to pay a significant share of states’ Medicaid costs, no matter how much enrollment or spending rose. Instead, the bill would have given the states a choice between a fixed annual sum per recipient or a block grant, both of which would have almost certainly led to major cuts in coverage over time.

The nonpartisan Congressional Budget Office predicted that the Republican bill would have cumulatively cut projected spending on Medicaid by $839 billion and reduced the number of Medicaid beneficiaries by 14 million over the coming decade.

 

 

More States To Expand Medicaid Now That Obamacare Remains Law

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https://www.forbes.com/sites/brucejapsen/2017/03/26/more-states-to-expand-medicaid-now-that-obamacare-remains-law/#13cbbeaa19a6

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More states will pursue expansion of Medicaid health benefits for poor Americans under the Affordable Care Act after Republicans failed to repeal and replace the law.

The American Health Care Act, also known as Trumpcare, would’ve rolled back the ACA’s Medicaid expansion and put restrictions on states that tried to expand such coverage. But Speaker of the U.S. House of Representatives Paul Ryan Friday pulled the ACHA legislation Friday, making, “Obamacare the law of the land,” as he said.

At least two states– Kansas and North Carolina–are already working toward becoming the 32nd and 33rd states to expand Medicaid  under the ACA. They would join 31 states plus the District of Columbia that have taken advantage of generous federal funding available under the law, President Obama’s signature legislative achievement, according to the Advisory Board.

 And there may be even more states that will resurrect state legislative efforts to expand Medicaid. Before Trump was elected, Georgia, Idaho, Nebraska and South Dakota were considering Medicaid expansion. But Trump’s election, along with Republican control of Congress, prompted these states to put on the brakes for Medicaid expansion when an ACA repeal looked likely. “The effort to expand Medicaid in Georgia just died,” the Atlanta Journal-Constitution said Nov. 9, 2016, the day after Trump won the electoral college.

From 2014 through 2016, the ACA’s Medicaid expansion population is funded 100% with federal dollars. Beginning this year, states gradually have to pick up some costs, but the federal government still picks up 90% or more of Medicaid expansion through 2020. It was a better deal than before the ACA, when Medicaid programs were funded via a much less generous split between state and federal tax dollars.

With the federal funding still part of the ACA, Kansas lawmakers just last week were forging ahead and now have a hurdle lifted with the law in place for the “foreseeable” future, as Speaker Ryan said. A so-called “manager’s amendment” in Ryan’s failed ACHA bill took specific aim at Kansas and North Carolina, making the states “long shots” at expanding Medicaid until Friday’s failed Obamacare repeal.

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.

 

In This Next Phase Of Health Reform, We Cannot Overlook Long Term Care

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http://healthaffairs.org/blog/2017/03/16/in-this-next-phase-of-health-reform-we-cannot-overlook-long-term-care/

It is becoming apparent that President Trump and the 115th Congress cannot start over with health care reform. Whether you love, begrudgingly support, or fervently hate the Affordable Care Act (ACA), a clean slate is not possible. First, ACA implementation is well underway and has benefited many patients and providers alike. Second, it is unlikely that Republicans in Congress can fully repeal the ACA without a 60 vote, filibuster proof super majority in the Senate. Starting over entirely with health reform is just not feasible.

Trying to address every problem facing the health care system at once is a tall—if not impossible—order. History has taught us that U.S. health reform is an incremental process. With the focus of Congress once again turning to health reform, we have an opportunity to fix the problems with the ACA, and find solutions to health care challenges that the ACA failed to address.

A Growing Need

Long-term care for America’s growing elderly population is a critically important issue for Congress to address in health reform proposals currently taking shape. While the ACA’s insurance expansion focused on providing coverage for the uninsured, the law’s progress on long-term care has been minimal. The ACA tried to address long-term care (LTC) by creating a voluntary system of LTC insurance, but the ill-fated CLASS Act was ultimately determined to be financially unviable and abandoned.

Although policy solutions have been elusive, the need for long-term care is constantly growing. According to current estimates, over two-thirds of elderly Americans will need LTC assistance at some point in their lives. Between 2014 and 2040, the portion of Americans over age 65 is expected to increase from 14.5 to 21.7 percent. At upwards of $60,000 annually, long-term care costs can quickly exhaust personal savings.

As policymakers throughout our history have debated health reform, these efforts have almost entirely centered on questions of medical coverage. They ask which benefits to cover, how much the coverage should cost, and how we can ensure people are not locked out of coverage because of their health status. We must take the same approach to LTC, examining the availability and affordability of services. LTC services include nursing home care and in-home care, as well as what is often referred to as “long-term services and supports” (LTSS). LTSS include assistance with daily activities, such as eating, bathing, dressing, doing laundry, paying bills, and taking medications.

Current Republican health reform proposals appear to do little to push the ball forward on long-term care. As Congress considers proposals to reduce federal spending on Medicaid, they should carefully consider the role of Medicaid in financing LTC.

 

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

Image result for What Does The House Health Care Bill Mean For California?

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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.

California Employer Health Benefits: Prices Up, Coverage Down

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http://www.chcf.org/publications/2017/03/employer-health-benefits

Since 2000, the percentage of employers offering health benefits has declined in California and nationwide, although coverage rates among offering firms have remained stable. Only 55% of firms reported providing health insurance to employees in 2016, down from 69% in 2000. These findings underscore the important role that Medi-Cal and Covered California play in providing insurance to working Californians — coverage that could be negatively impacted by the Republicans’ repeal and replacement of the Affordable Care Act.

Nineteen percent of California firms reported that they increased cost sharing in the past year, and 27% of firms reported that they were very or somewhat likely to increase employees’ premium contribution in the next year. The prevalence of plans with large deductibles also continues to increase.

California Employer Health Benefits: Prices Up, Coverage Down presents data compiled from the 2016 California Employer Health Benefits Survey.

Other key findings include:

  • Health insurance premiums for family coverage grew by 5.6%. Family coverage premiums have seen a cumulative 234% increase since 2002, compared to a 40% increase in the overall inflation rate.
  • The average monthly health insurance premium, including the employer contribution, was $597 for single coverage and $1,634 for family coverage in California, and was significantly higher than the national average.
  • 41% of workers in small firms faced an annual deductible of at least $1,000 for single coverage, compared to 17% of workers in larger firms. The prevalence of these higher deductibles in small firms has increased substantially in the past five years.
  • Only one in four firms with many low-wage workers (those earning $23,000 or less) offered health coverage to employees in 2016.
  • In the past year, 24% of large firms extended eligibility for health benefits to workers not previously eligible.

The complete Almanac report, as well as past editions, is available under Document Downloads.

Medicaid Is About Grandma

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http://www.huffingtonpost.com/entry/medicaid-is-about-grandma_us_58c823d8e4b022817b29178d?utm_campaign=KHN%3A%20Daily%20Health%20Policy%20Report&utm_source=hs_email&utm_medium=email&utm_content=45675040&_hsenc=p2ANqtz-8LGIyTmn6nhDk89cZo6cUrufFATTTJ0UEOLkEAL40dVGaTTKG-_3pnWLxOkvp2OhsqJnaKQT0UF6ciBSrrzUF_dRYROg&_hsmi=45675040

Image result for medicaid grandma in nursing home

Why don’t Democrats more often make the point Sen. Chuck Schumer made this week about the consequences of GOP efforts to scuttle Medicaid:

Medicaid is for poor people, but also 60 percent goes to people in nursing homes. And that affects not only them, but their kids. You’re a kid 45 or 50, your Mom or Dad is in a nursing home. They could be kicked out after this bill passes. What would you do? You have to take them at home, stop working to take care of them. Or you have to shell out thousands of dollars out of your pocket. — Schumer press conference (3/13)

Bill Clinton routinely made this point when Medicaid was debated during his presidency. Inexplicably he is among a surprisingly few Democrats who stress the program’s service to elder Americans in dire need of long term care. But the GOP continues to get away with feeding the illusion that it mostly serves malingerers who’d rather take a federal handout than get a job.

Baby boomers everywhere are facing the painful needs of parents who need nursing home care. Many are finding that Medicaid is their only choice. That’s the political pitch that can save Medicaid.

Repealing the Affordable Care Act

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https://www.brookings.edu/blog/unpacked/2017/03/08/repealing-the-affordable-care-act/?utm_campaign=Economic%20Studies&utm_source=hs_email&utm_medium=email&utm_content=45259936

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THE ISSUE: If Congress rejects the new House Republican-backed replacement for the Affordable Care Act (ACA), the full repeal long advocated for by many Republicans could be their next option.

A straight ACA repeal would leave an estimated 20+ million people without health coverage.

THE THINGS YOU NEED TO KNOW

  • Republicans have long advocated for repealing the ACA and if their new replacement isn’t approved, that plan could soon be put into motion.
  • The ACA provides coverage, and subsidies towards coverage, to people who previously couldn’t get health insurance through the individual market.
  • A straight ACA repeal would leave an estimated 20+ million people without health coverage.
  • If the ACA is repealed, many lower-income Americans (earning a maximum family income of about $33,000) participating in Medicaid, which was expanded under the ACA, would lose health coverage.
  • Many individuals with pre-existing medical conditions, previously unable to get health insurance, would also lose coverage.
  • The ACA also benefits health insurance industry by stabilizing coverage, and provides assurance to state hospitals that patients have coverage of some kind.
  • It is incumbent upon Republicans to provide a clear plan and implement it quickly in order to stabilize the markets and assure Americans that whatever replaces the ACA will be at least as good and at least as affordable as their current plans.
  • Polling on repeal shows that people are unhappy with the ACA, but not with their coverage. They most frequently criticizes the cost and the availability of coverage.
  • Republicans are faced with a challenge: Americans don’t just want repeal, they want a replacement that is comprehensive and affordable.