Tag Archives: Medicaid
Rolling Back the ACA’s Medicaid Expansion: What Are the Costs for States?
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.
How Would Republican Plans for Medicaid Block Grants Actually Work?
How Would Republican Plans for Medicaid Block Grants Actually Work?
There are only so many ways to cut Medicaid spending.
You can reduce the number of people covered. You can reduce the benefit coverage. You can also pay less for those benefits and get doctors and hospitals to accept less in reimbursement. Or you can ask beneficiaries to pay more.
None of those are attractive options, which is why Medicaid reform is so hard. Medicaid already reimburses providers at lower rates than other insurance programs. How do you reduce the number of beneficiaries when the vast majority of people covered are poor children, poor pregnant women, the disabled, and poor older people? Which of those would you cut?
Reducing benefit coverage has always been difficult because most of the spending has been on the disabled and poor older people, who need a lot of care. Beneficiaries don’t have much disposable income, so asking them to pick up more of the bill is almost impossible.
That doesn’t mean that states haven’t tried. As I’ve discussed in past columns, a number are attempting to increase cost sharing. But this isn’t really a solution because it doesn’t change overall spending much at all.
Part of the challenge lies in the way Medicaid was set up in the first place. The federal government picks up between 50 percent and 100 percent (depending on the population and the per-person income) of whatever it costs to provide health care to a state’s population. Many, if not most, Republican plans would like to change that.
They are pushing for what many refer to as a block grant program. The federal government would give a set amount of money to each state for Medicaid; it would be up to the states to spend it however they like. These block grants could be set based on overall past state needs or based on the number of beneficiaries in the state, referred to as a “per capita” block grant. Some per-capita block grants function more like “ceilings” than outright grants, allowing the state to be paid at normal Medicaid rates, but with a maximum each state could get based on the per-capita calculation.
Everything You Need to Know About Block Grants: The Heart of GOP’s Medicaid Plans
President Donald Trump’s administration made explicit this weekend its commitment to an old GOP strategy for managing Medicaid, the federal-state insurance plan that covers low-income people — turning control of the program to states and capping what the federal government spends on it each year.
It’s called “block granting.” Right now, Medicaid, which was expanded under the 2010 health reform to insure more people, covers almost 75 million adults and children. Because it is an entitlement, everyone who qualifies is guaranteed coverage and states and the federal government combine funds to cover the costs. Conservatives have long argued the program would be more efficient if states got a lump sum from the federal government and then managed the program as they saw fit. But others say that would mean less funding for the program —eventually translating into greater challenges in getting care for low-income people.
Block granting Medicaid is a centerpiece of health proposals supported by House Speaker Paul Ryan and Rep. Tom Price, Trump’s nominee to run the Department of Health and Human Services. This weekend, Trump adviser Kellyanne Conway emphasized the strategy as key to the administration’s health policy.
But what would this look like, and why is it so controversial? Let’s break down how this policy could play out, and its implications — both for government spending and for accessing care.
Q: How would a block grant work?
Medicaid Reform: The Elephant in the Room
While headlines fixate on the future of the Affordable Care Act’s health insurance exchanges, a more consequential fight is brewing over the future of Medicaid. Proposed reforms would affect tens of millions of Americans and state governments across the country. Previous attempts have failed, however, and longstanding roadblocks may sink this administration’s efforts as well.
With over 70 million enrollees, Medicaid covers more Americans than any other insurer. Responsibility for funding the program – which accounts for nearly 20 percent of all healthcare spending – is shared between states and the federal government. At a minimum, the federal government covers 50 percent of costs, with that share rising to nearly 75 percent in the poorest states and more than 90 percent for those covered through ACA Medicaid expansions. This amounts to nearly $350 billion in federal funding per year.
Importantly, this money is allocated in an open-ended manner. As states increase the generosity of their Medicaid programs, the federal government is obliged to pay its portion of the higher costs.
During his campaign, Donald Trump joined a long list of Republican lawmakers who argue that this gives states the wrong incentives. Because the federal government covers at least half of each dollar spent, they argue, states may take less care to weed out inappropriate and inefficient spending as they otherwise would.
To eliminate this open-ended feature, Trump’s plan calls for federal money to be allocated in fixed lump sum payments known as block grants.
First proposed in 1981 by President Reagan, block granting of Medicaid hardly represents a novel policy option. Why then has the current system endured, and what does this portend for the resistance Trump’s efforts may encounter?
To understand, consider the most basic decision for any block grant policy: How should each state’s grant be initially determined?
Centene to stay on ACA exchanges; WellCare grows Medicaid membership
Unlike some of the other major for-profit health insurers, Centene has no plans to consider exiting the Affordable Care Act exchanges in 2018.
“I’m not backing off at all,” CEO Michael Neidorff said during the company’s fourth-quarter earnings call Tuesday. In recent discussions with the company’s board members, he said, “everybody is of one mind; you maintain business as usual.”
Recently, the CEOs of Anthem and Cigna both indicated they are still deciding whether to participate on the exchanges in 2018. Aetna, meanwhile, does not plan to re-enter any markets in 2018 after pulling out of many in 2017.
As of Dec. 31, Centene served about 540,000 exchange members, in line with its expectations, and it anticipates having a little more than 1 million paid members in 2017. Indications are that the demographics of these members will be consistent with years past, with 90% of them subsidy-eligible and most on silver-tier plans, Neidorff said.
While Centene is folding an “extra level of conservativism” into its expectations for its exchange products to guard against any uncertainty, it continues to expect that line of business to be profitable this year, he added.
Another ACA provision, Medicaid expansion, has also proved profitable for Centene. At the end of 2016, it had 1,080,500 members in Medicaid expansion programs in 10 states, compared to 449,000 members at the end of 2015, according to the company’s earnings statement.
Healthcare Triage News: Many with Employer Insurance Still Need CHIP to Insure Their Kids
Healthcare Triage News: Many with Employer Insurance Still Need CHIP to Insure Their Kids
As employer-sponsored insurance becomes more expensive for children, public programs are picking up the slack. This is Healthcare Triage News.
Covering the Coming Battle Over the ACA: What You Need to Know
California’s Projected Economic Losses under ACA Repeal
Click to access Californias-Projected-Economic-Losses-under-ACA-Repeal.pdf
If Congress follows through on President-elect Trump’s campaign promise to repeal the Affordable Care Act (ACA), 3.7 million Californians enrolled in the Medi-Cal expansion would lose that coverage,1 and another 1.2 million individuals enrolled through California’s health benefit exchange, Covered California, would lose federal subsidies to make private health insurance more affordable.2 These two ACA provisions are the largest drivers of the historic reduction in the state’s uninsured rate from 17.2% in 2013 to 8.6% in 2015.
Not only would repeal of the ACA reverse much of these coverage gains, but California would lose approximately $20.5 billion in annual federal funding for the Medi-Cal expansion and Covered California subsidies. The economic losses associated with these lost federal dollars would be partially offset by limited economic gains from other provisions that may be included as part of the repeal of the ACA, which could yield $6.3 billion in tax cuts to California insurers and high-income households and nearly $1.3 billion in eliminated penalties for uninsured individuals and employers not offering affordable coverage.
In this brief, we estimate the effects on employment, gross domestic product (GDP), and state and local tax revenue in California with the elimination of the major health insurance expansions, reduction in taxes, and removal of penalties under a partial repeal of the ACA. A summary of these estimates is shown in Exhibit 1. We also estimate losses for select medium and large counties that would be especially harmed economically by ACA repeal because of their high share of population (more than 10%) enrolled in the Medi-Cal expansion: Fresno, Kern, Los Angeles, San Bernardino, San Joaquin, Stanislaus, and Tulare Counties.
CONCLUSION
The ACA not only significantly expanded access to health insurance in California, but it also provided economic stimulus at a time when the state was still recovering from the Great Recession. As California is one of the states that made the greatest gains in health coverage under the ACA,16 it is also one of the states with the most to lose economically if key components of the ACA are repealed. The partial repeal of the ACA would not only lead to a substantial decline in health coverage in California, but it would also lead to significant economic losses, including more than 209,000 lost jobs, $20 billion in lost GDP, and $1.5 billion in lost state and local tax revenue. Some medium and large California counties’ economies – Fresno, Kern, San Bernardino, San Joaquin, Stanislaus, and Tulare – would be especially harmed due to their residents’ high level of reliance on the Medi-Cal expansion and above-average unemployment rates.
ACA Repeal in California: Who Stands to Lose?
Click to access ACA-Repeal-in-California.pdf
California has a lot to lose if the Affordable Care Act (ACA) is repealed. The state made significant investments in implementing the law successfully, and under the ACA cut the number of uninsured residents in half, from 6.5 million in 2013 to 3.3 million in 2015—the largest decline in the uninsured rate of any state.1 The two major reasons for this drop in uninsurance were the expansion of Medicaid and the provision of financial assistance for purchasing coverage through the state health insurance marketplace, Covered California. As a result of these policies, California experienced a significant reduction in health coverage disparities: the biggest drops in the uninsurance rate were among those least likely to have coverage before the ACA, namely those with the lowest income, young adults, part-time workers, and Latinos.2 Repealing the ACA threatens not only to leave millions without health insurance, but also to undo the progress California has made in reducing inequality of health insurance access. This brief focuses on Californians enrolled in expanded Medi-Cal (the state’s Medicaid program) and those who receive subsidized coverage through Covered California, the two groups most immediately affected if the ACA is repealed. However, many more Californians could see diminished health coverage under various Congressional Republicans’ proposals to repeal and replace the ACA.
