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Uninsured Rate Rose in 2017

The rate of uninsured Americans rose in 2017, the first such increase since implementation of the Affordable Care Act.

According to a new Urban Institute study,

The increasing uninsurance rate between 2016 and 2017 was driven by losses of private nongroup coverage, such as that purchased in the health insurance marketplaces, and decreases in Medicaid and Children’s Health Insurance Program (CHIP) coverage (-0.4 percentage points each).

In addition,

Overall, coverage losses were concentrated in the 19 states that did not expand Medicaid eligibility under the Affordable Care Act by July 1, 2017…Between 2016 and 2017, uninsurance held stable in Medicaid expansion states but increased by 0.5 percentage points in nonexpansion states.

The study also noted that these declines occurred at a time when the economy was considered strong, incomes were rising, and more employers were sponsoring insurance coverage.

Learn more about where and why the number of uninsured people rose in 2017 in the Urban Institute report “Health Insurance Coverage Declined for Nonelderly Americans Between 2016 and 2017, Primarily in States That Did Not Expand Medicaid.”

More Medicaid Matching Funds for Only Partial Medicaid Expansion?

The federal government is considering providing an unusual amount of federal Medicaid matching funding for only partial state Medicaid expansion.

At least that’s what Centers for Medicare & Medicaid Services administrator Seema Verma told a health care conference in Georgia last week.

The state of Georgia has proposes partially expanding its Medicaid population.  Under the Affordable Care Act, states that fully expand their Medicaid programs under the terms established by the 2010 health care law receive nine dollars in federal matching funds for every one dollar they spend on their Medicaid expansion population.  States that only partially expand their Medicaid programs, on the other hand, currently are eligible to receive only their usual federal matching rate:  generally one federal dollar for every state dollar, with states with higher poverty rates receiving as much as slightly more than three dollars for every state dollar they spend.

Last week, however, CMS’s Verma said that when Georgia submits its Medicaid waiver application to CMS seeking only partial expansion of its Medicaid program, the federal agency will consider providing Affordable Care Act-level Medicaid matching funds rather than the traditional federal Medicaid matching rate.

Such a policy shift could be very beneficial for private safety-net hospitals in states that have not expanded their Medicaid programs, extending coverage to some of the currently uninsured, low-income residents of the communities in which those hospitals are located.

Learn more about the Georgia plan for partial Medicaid expansion and the possibility of CMS treating it like an Affordable Care Act Medicaid expansion in the Atlanta Journal-Constitution article “Trump official open to increased funding for Georgia Medicaid waiver.”

Pay Raise Didn’t Lead More Docs to Participate in Medicaid

The temporary rate increase that the Affordable Care Act provided as means of encouraging more doctors to serve Medicaid patients did not work, according to two new studies published in the journal Health Affairs.

According to the studies, the increase in the number of physicians who decided to begin serving Medicaid patients as a result of the fee increase was negligible.

Among the reasons the studies’ authors offer for the lack of growth in the participation of doctors are the limited nature of the pay raise and the documentation required to receive it.

Despite this, the authors note, access to care did improve as a result of the Affordable Care Act’s Medicaid expansion.

Learn more about the studies, their results, and their significance by going here to see the Health Affairs report “No Association Found Between The Medicaid Primary Care Fee Bump And Physician-Reported Participation In Medicaid and here for the study “Physicians’ Participation In Medicaid Increased Only Slightly Following Expansion.”

A New Wave of Medicaid Expansion?

Spurred by the Trump administration’s invitation to states to apply for approval to make work requirements a part of their Medicaid program, a number of states that spurned the opportunity created for expansion under the Affordable Care Act may consider pursuing Medicaid expansion in the near future.

Currently, some elected officials in Idaho, Kansas, North Carolina, Utah, Virginia, and Wyoming appear to be considering what they once considered unthinkable:  making more of their residents eligible for Medicaid.

For the most part, expansion talk is coming from moderate Republican legislators who believe a work requirement may help soften the staunch opposition to Medicaid expansion among their more conservative Republican colleagues – and at this point it is all still just talk.

Ten states have already sought federal approval to establish a work requirement as part of their Medicaid programs and one state, Kentucky, has already had such a request approved.

Learn more about how a federal move to reduce the number of people on the nation’s Medicaid rolls may actually result in an increase in nation-wide Medicaid enrollment in this Washington Post story.

ACA Improves Access to Surgical Services

The Affordable Care Act’s Medicaid expansion has improved access to surgical services for Medicaid patients.

Or so says a new study published in JAMA Surgery, which reports that

In this study of patients with 1 of 5 common surgical conditions, Medicaid expansion was associated with a 7.5–percentage point increase in insurance coverage at the time of hospital admission. The policy was also associated with patients obtaining care earlier in their disease course and with an increased probability of receiving optimal care for those conditions.

As a result, the study found,

The ACA’s Medicaid expansion was associated with increased insurance coverage and improved receipt of timely care for 5 common surgical conditions.

This development is especially relevant to private safety-net hospitals because they serve so many more Medicaid patients in the predominantly low-income communities in which they are located.

Learn more about the study, its findings, and the implications in the JAMA Surgery report “Association of the Affordable Care Act Medicaid Expansion With Access to and Quality of Care for Surgical Conditions,” which can be found here.

Medicaid in the Spotlight

State-option work requirements.

A cap on federal spending.

New flexibility for states to address eligibility, benefits, and provider payments.

Rolling back the Affordable Care Act’s eligibility expansion.

Medicaid is under the policy microscope in Washington these days in ways it has not been for many years as the new administration continues to work to put its stamp on the federal government’s major program to provide health care to low-income Americans.

These and other possible changes are of great interest to the nation’s private safety-net hospitals because these hospitals care for so many more Medicaid and low-income patients than the typical community hospital.

What are policy-makers considering and what are the potential implications of their efforts?  Learn more in the new Health Affairs blog article “Medicaid Program Under Siege,” which can be found here.

Medicaid Enrollees: Access and Quality Are Good

Medicaid beneficiaries are generally satisfied with their access to care and the quality of care they receive.

Or so reports a new study based on results of the federal Medicaid Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey for December of 2014 to July of 2015.

According to the survey, nearly half of Medicaid patients rated their overall care 7.9 or greater on a scale of 10; 84 percent reported that they had been able to receive all of the care they needed over the past six months; and most were generally satisfied with the coverage.  Relatively few reported problems finding providers willing to accept their Medicaid coverage.

Survey results generally were slightly more positive in Medicaid expansion states than in non-expansion states.

Private safety-net hospitals serve especially large numbers of Medicaid patients.

Learn more about how Medicaid beneficiaries view the quality and accessibility of the care they receive in the JAMA Internal Medicine report “What Enrollees Think of Medicaid | Health Care Reform,” which can be found here.

Insurance Expansion and Health Status

A new study suggests that the Affordable Care Act’s insurance and Medicaid expansion is improving the health of both Medicaid recipients and the uninsured.

According to the study, the health of Medicaid recipients and the uninsured was better in 2014 than in 2013.

health affairsMany patients of the nation’s private safety-net hospitals have benefited from the improved access to health insurance and especially the expansion of Medicaid eligibility made possible by the Affordable Care Act.

To learn more, see the article “Changes In Health Status And Care Use After ACA Expansions Among The Insured And Uninsured” here, on the web site of the journal Health Affairs.

Traditional vs. Section 1115 Medicaid Expansion

While most states that took advantage of the Affordable Care Act to expand their Medicaid programs did so simply by expanding the population eligible to participate in the program, some expanded through the use of what are known as section 1115 waivers, which are defined as “experimental, pilot, or demonstration projects that promote the objectives of the Medicaid and CHIP programs.”

Most of those waivers involve the use of new delivery systems, such as greater use of managed care, and six states implemented their Affordable Care Act Medicaid expansion through section 1115 waivers.

health affairsWhy the alternative approach? While for some states it simply is a matter of trying new delivery systems, a recent post on the Health Affairs Blog suggests another motive:

These waivers are not clearly being sought because different states have different populations or demographics in need of different benefit packages. Rather, they are being sought for other reasons, because of the political concerns at work in many of these states, rhetoric around values including personal responsibility, and the desire to minimize additional spending on Medicaid populations.

The Health Affairs Blog post takes a closer look at what section 1115 waivers involve, why states use them instead of pursuing more traditional Medicaid expansion, and what the potential dangers of this mechanism might be. Go here to see its feature “Medicaid Expansion Through Section 1115 Waivers: Evaluating The Tradeoffs.”

 

States Seeking Job Search as Condition for Medicaid Expansion

A number of states that have resisted expanding their Medicaid programs are now attempting to do so by linking expansion to requiring new participants to enroll in job search and training programs.

The Centers for Medicare & Medicaid Services, which must approve Medicaid expansion plans, has rejected proposals from Indiana, Montana, and New Hampshire that had such requirements and is currently reviewing a similar proposal from Arkansas. Arkansas already has expanded its Medicaid program but is threatening to drop its expansion unless CMS permits it to modify its current approach.

iStock_000014445371XSmallCMS does not prevent states from incorporating job search and employment training into their Medicaid programs but so far has not permitted them to make participation in such efforts mandatory.

For a closer look at this issue, including what states are proposing and how CMS is responding, see this CQ Roll Call report presented by the Commonwealth Fund.