Medicaid – Page 4 – The Moral Healthcare Blog

Medicaid’s high marks on preventive care contrary to its stingy image – amednews.com

Medicaid, with its reputation for low payment rates and fiscal instability, is far from perfect, said Stacey Mazer, senior staff associate for the National Assn. of State Budget Officers. Budget officers in particular continue to have concerns about the fact that health care spending is outpacing other services.

Kaiser’s findings highlight all of the positive benefits that Medicaid can provide, Mazer said. “The states did very well in terms of the number of preventive services that they covered, and even the states that didn’t cover as many still covered the majority of them.”

Medicaid Expansion Reduces Mortality, Study Finds – Capsules – The KHN Blog

As states decide whether to expand their Medicaid programs to cover low-income childless adults, the impact of their choices became clearer today in a study showing a reduction of mortality in states that have already made that move.

The research published in the New England Journal of Medicine found a 6.1 percent reduction in mortality among low-income adults between the ages of 20 and 64 in Maine, New York and Arizona — three states that expanded coverage since 2000, compared with similar adults in New Hampshire, Pennsylvania, Nevada and New Mexico, neighboring states that did not do so.

The decline in mortality, by an overall 19.6 deaths per 100,000 adults, was especially pronounced among older individuals, minorities and residents of the poorest counties. The researchers analyzed data spanning five-year periods before and after the three states extended their Medicaid coverage to poor, childless adults.

The study also found “improved coverage, access to care and self-reported health” among the newly covered adults.

The Fiscal Facts about Medicaid Expansion – Doctors for America

Currently, the federal government requires that Medicaid be available to adults who 1) fall under the federal poverty line and 2) who have children, are pregnant, or are disabled. Although Medicaid is almost entirely administered by the states, including actual enrollment of beneficiaries and reimbursement to health care providers, the cost is split between the federal and state governments, with the federal government shouldering, on average, about 57% of cost.

There are two ways that the ACA will expand enrollment in Medicaid. First, the ACA makes more Americans eligible for the program by 1) increasing the income standard to 133% of the federal poverty level (in 2011 this was $10,890 for individuals and $22,320 for a family of four), and 2) doing away with the requirement that you must have children, be pregnant, or be disabled. The ACA ensures that the Federal government would pay for 100% of this the first 3 years, then phase down to 90% after 2020 and beyond. According to the Congressional Budget Office and the Center for Budget and Policy Priorities, this averages to the Federal government paying for 93-94% of the expansion over the rest of the decade.

The second way is that the ACA simply makes it easier for eligible Americans to enroll in the program. The little known truth is that there are millions of Americans who are already eligible for Medicaid but are not enrolled because of complicated paperwork for potential beneficiaries and for state agencies and providers. In fact, a New England Journal of Medicine paper reports that only 62% of all eligible individuals are enrolled in Medicaid, with some states like Oklahoma, Texas, and Florida enrolling under 48%. The issue is even more is true for children; 60-70% of uninsured children are eligible for Medicaid or State Children’s Health Insurance Programs (CHIP) eligible but are not enrolled.

Flaws And All, Medicaid Can Improve Adults’ Health : Shots – Health Blog : NPR

But a study just published online by the New England Journal of Medicine adds to a growing body of evidence that Medicaid, in fact, does improve the health of those it covers.

The study, whose Harvard-affiliated authors include one currently advising the Obama administration and one who worked for President George W. Bush, compared three states (New York, Maine, and Arizona) that expanded Medicaid coverage to childless, non-disabled adults in recent years to three neighboring states that did not. Those adults will be the primary beneficiaries of the expansion envisioned under the Affordable Care Act.

It found that Medicaid expansions were associated with “a significant reduction in adjusted all-cause mortality,” as well as decreased rates of care being delayed due to cost, and more people reporting themselves to be in “excellent” or “very good” health.

Now if that sounds obvious, it’s not. “Prior to Oregon, we didn’t have very good data for adults” and Medicaid, lead author Benjamin Sommers told Shots.

By Oregon, he’s referring to a landmark study from last year that was able to compare adults who got Medicaid coverage through a lottery with those who didn’t. Such a randomized trial is almost unheard of in health policy research because it most cases it would be unethical. The Oregon study was facilitated by state budget considerations.

One reason critics of Medicaid have been able to maintain the debate is that some earlier studies have, indeed, found that people with Medicaid, particularly adults, sometimes had worse medical outcomes than those who didn’t.

Sommers says that should hardly come as a shock. “We know Medicaid is designed to cover the sickest of the sick” he says. “So it’s not surprising that people who have Medicaid do worse than those who don’t.”

Sommers says this new study, which includes some of the same team working on the Oregon data, complements that one. “While it’s not a randomized study,” he said, it has a larger sample (more than 68,000 people) and examines a longer period of time (five years before and after the Medicaid expansion).

Federal Government Will Pick Up Nearly All Costs of Health Reform’s Medicaid Expansion — Center on Budget and Policy Priorities

Claims that states will bear a significant share of the costs of the Affordable Care Act’s (ACA) Medicaid expansion — and that this will place a heavy financial burden on states — do not hold up under scrutiny. Congressional Budget Office (CBO) analysis indicates that between 2014 and 2022, the ACA’s Medicaid expansion will add just 2.8 percent to what states spend on Medicaid, while providing health coverage to 17 million more low-income adults and children. In addition, the Medicaid expansion will produce savings in state and local government costs for uncompensated care, which will offset at least some of the added state Medicaid costs.

Medicaid payments to primary-care doctors will rise under new regulation – The Washington Post

Medicaid payments to primary-care doctors will rise under new regulation – The Washington Post: Primary care doctors could get a pay raise next year for treating Medicaid patients, under a rule announced by the Obama administration Wednesday.

The proposed regulation implements a two-year pay increase included in the 2010 health-care law. The increase, effective in 2013 and 2014, brings primary care fees for Medicaid, which covers indigent patients, in line with those for Medicare, which insures the elderly and some disabled patients.

Although Medicaid is jointly funded by states and the federal government, the pay boost would be covered entirely with federal dollars totaling more than $11 billion over the two years it would be in effect.

Congress automatically appropriated those funds when it adopted the health-care law, so it will not need to act now.

However, the provision is among hundreds that could be instantly nullified if the Supreme Court decides to overturn the law in its entirety when it rules on the constitutional challenge. The court heard arguments on the case in March, and a decision is expected late next month.

The pay raise is one of several attempts in the law to address a fundamental challenge in U.S. health-care: Because primary care doctors focus on preventive care, they offer the best hope of curbing the nation’s health spending. Yet they are paid far less than specialists, contributing to a shortage of primary care doctors that is projected to grow with the aging of baby boomers, the retirement of physicians and an expected influx of more than 30 million Americans who will gain insurance through the health-care law beginning in 2014.

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Myopia

[Originally posted at Doctors for America’s Progress Notes Blog]

Andrew Sullivan’s tag line, via George Orwell, is that “It is a constant struggle to see what is past the end of one’s nose.” One of my favorite lines is from Upton Sinclair, “It is difficult to get a man to understand something if his livelihood depends upon his not understanding it.”

When I say “favorite,” I mean I like it because it says a lot about the human condition in general, and about our political struggles in particular. Unfortunately, in these times, this myopia in our world views has the potential to lead to human misery, and to continue America on the road to tragedy, as we already have passed farce. I consider myself an optimist, but recent events including our world class embarrassment of a debt ceiling “deal” have left me pessimistic for our short term prospects of reinvigorating our priorities as a nation and consequently our intermediate term prospects of leaving the nation better than we found it.

We have been at our best as a nation when we have had visionary leadership, from Teddy Roosevelt’s “Square Deal,” to Franklin Roosevelt’s “New Deal,” to LBJ’s “Great Society.” Even Eisenhower’s more mundane Interstate Highway System and JFK’s goal to put a man on the moon represent aspirational goals for America. (“We chose to do these things, and the others, not because they are easy, but precisely because they are hard!”) Now, our political will has been demeaned to the lowest common denominator: how will I keep more of my meager income for myself in the short term?

Paul Krugman, Robert Reich, and others have been banging this drum for over a decade now: investing in human capital is the way to grow the economy and keep us a great country. Many wish to continue the defunding of our societal investment in human capital: reducing investments in education and research, reducing money spent on the health of the population, demolishing our social welfare programs like Medicare, Medicaid, SCHIP and Social Security. This is short sighted and a recipe for disaster (with all the ingredients mise en place).

We now have plugged in a small group of Congress Persons in the wildly inappropriately named “Super Congress,” with the stated goal of resolving our budget stalemate. I am skeptical, to say the least, and two articles in this week’s New England Journal of Medicine reinforce my pessimism.
Jonathon Oberlander points out that “austerity politics” are now in force, and there are real potential dangers that Medicare and Medicaid funding could be cut substantially, including reduced payments to providers, reductions in federal funds for state Medicaid programs, increasing cost-sharing for enrollees, repealing the long term care insurance provisions in the ACA, and – per Paul Ryan’s plan – changing Medicare into a voucher plan.

While Oberlander doesn’t say it, I will: the “austerity politics” manufactured in Washington by power brokers with lots of money behind them are designed to take an axe to the programs that provide medical care to those who need it and prevent expansion to those who need it even more. We at DFA are all too aware of deficiencies in our current health care system and are not shy at all about pointing them out. But we also know that reforming health care requires a greater intellectual effort than unthinking cuts born out of myopic political calculations.

In the same NEJM issue, Christopher Jennings notes that many stakeholders in health care are coming to realize that there is almost no good that can come out of the work of the Super Committee. Because of the construction of the debt ceiling deal, if the Super Committee reaches no deal and the “automatic cuts” are enacted, Medicaid is exempt from cuts and Medicare would face “only” a two percent cut. As he explains, it is hard to imagine a deal crafted by the twelve that would so good to health care funding:

From the current vantage point of these stakeholders, the choice is therefore not a close call; the automatic cuts are by far the best poison to be forced to take, particularly in comparison to the concoction they fear the super committee could produce. It would meet the requirement of the law, protect against unknown and much larger cuts, and preserve resources and bargaining chips for the next big deal, which will probably take place in 2013 after the presidential election.

So, there is hope, if I ditch my own myopia and hope and pray and work for a new, better Congress in 2013, we may be able to get on the path to becoming a great country again, instead of the “dollar store” nation that so many seem to believe is our destiny!

Public Citizen | Publications – Report: Equal Pay for Equal Work? Not for Medicaid Doctors (HRG Publication #1822)

Public Citizen Publications – Report: Equal Pay for Equal Work? Not for Medicaid Doctors (HRG Publication #1822):

The states that had the lowest ratios and therefore had the highest
disparities in Medicaid and Medicare payments in 2003 now have the following
Medicaid-to-Medicare ratios:
Medicaid-to-Medicare Fee Ratios for Selected Primary Care Procedures,
Low-Parity States, 2007

New York .29
New Jersey .31
Rhode Island .40
Pennsylvania .42
District of Columbia .48

Read the full report to get the idea, but what we in healthcare have known all along is that Medicaid is de facto rationing. It is a severe economic disincentive to serve this population. And it is worth noting that, depending upon where you practice, Medicare is likely your lowest payer to begin with, so these numbers become even more tragic.