“A new article in Health Affairs brings attention to the problem of ‘churning’ in the eligibility requirements for subsidized ObamaCare. The study by Benjamin Sommers and Sara Rosenbaum looks at how often people will fall in and out of eligibility for, on one hand, Medicaid for people up to 133% of the poverty level, and on the other hand, subsidized coverage for those up to 400% of poverty in the Exchange.”
“Bottom line: after we get through 10 years of spending our $1 trillion under ObamaCare, there is no convincing reason to believe that the bottom half of the income distribution will have more care, better care, or better access to care than they have today.”
“Already facing a challenging budget picture, Texas received more bad budgetary news with the release of the Texas Public Policy Foundation’s study Final Notice: Medicaid Crisis, A Forecast of Texas’ Medicaid Expenditures Growth.
The study by Jagadeesh Gokhale, a senior fellow at the Cato Institute, warns President Obama’s Patient Protection and Affordable Care Act (PPACA) will vastly increase the amount of money states have to spend on their Medicaid budgets.”
“States in the South and Mountain West, which traditionally have the lowest rates of primary care physicians, could struggle to provide medical services to the surge of new patients expected to enroll in Medicaid under the health overhaul and federal incentives may not provide much help, according to a report issued today by a Washington health research group.”
“My critics say that I’m ‘cynical’ because I say that Medicaid’s reimbursement rates are too low, and yet oppose spending more money that we don’t have. This is a false dichotomy. There are a lot of things we can do to make Medicaid more cost-efficient: starting with converting the program into block grants for the states, and letting states focus on fully funding care for the truly needy.”
“Under the Patient Protection and Affordable Care Act (PPACA), Medicaid enrollment is expected to grow by 16 million people by 2019, an increase of more than 25 percent. Given the unwillingness of many primary care physicians (PCPs) to treat new Medicaid patients, policy makers and others are concerned about adequate primary care capacity to meet the increased demand. States with the smallest number of PCPs per capita overall—generally in the South and Mountain West—potentially will see the largest percentage increases in Medicaid enrollment, according to a new national study by the Center for Studying Health System Change (HSC). In contrast, states with the largest number of PCPs per capita—primarily in the Northeast—will see more modest increases in Medicaid enrollment. Moreover, geographic differences in PCP acceptance of new Medicaid patients reflect differences in overall PCP supply, not geographic differences in PCPs’ willingness to treat Medicaid patients.”
“So why do Medicaid patients fare so badly? Payment to providers has been reduced to literally pennies on each dollar of customary charges because of sequential rounds of indiscriminate rate cuts, like those now being pursued in states like New York and Illinois. As a result, doctors often cap how many Medicaid patients they’ll see in their practices. Meanwhile, patients can’t get timely access to routine and specialized medical care… President Barack Obama’s health plan follows this logic. Half of those gaining health insurance under ObamaCare will get it through Medicaid.”
“At issue is a provision in the health-overhaul law enacted in 2010 that says states can’t limit Medicaid eligibility or else they’ll lose federal funding.
As a result, every one of the country’s 29 Republican governors has asked the federal government to waive the requirement, with New Jersey penciling a waiver into its budget. Some states with Democratic governors, including Washington, are also quietly pressing for the change.”
“To consider what the expansion of Medicaid under ObamaCare might do to the states, take a look at Massachusetts and Tennessee. In 2006, Massachusetts overhauled its entire health-care system, including a significant expansion of Medicaid. This expansion is costing the state far more than expected. Gov. Deval Patrick approved a record-setting $9.6 billion to cover its share of Medicaid costs last July. It wasn’t enough. He’s already gone back to the legislature twice, adding almost $600 million in additional funds.”
“This month, Jan Brewer of Arizona became the first governor to request what most of the states really need — a waiver from HHS freeing the states from an Obamacare provision known as the maintenance of effort requirements. This is a mandate that forces states to maintain their current Medicaid rolls until 2014 for adults and 2019 for children. If the states trim programs, they end up forfeiting all of Medicaid’s federal matching funds.”