Across plans and states, the expansion population experienced high disenrollment rates, indicating that, as in other Medicaid eligibility groups, there is substantial churn in this population.
• Even after adjusting for age and gender, claims costs increased steadily over time, suggesting that expansion enrollees have complex and/or chronic conditions.
— For some enrollment cohorts, average claims costs decreased modestly in the second half of the first year of enrollment, suggesting some initial pent-up demand for services, though claims costs increased steadily from that point forward.
• Across enrollment groups, per member per month spending on prescription drugs increased with enrollment duration.
— Among enrollees who remained enrolled the longest, inpatient claims initially made up the largest share of claims costs, but were surpassed by prescription drug claims by month 8 of enrollment, on average.
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Health care dominated the news cycle in 2017. Yet, for all the legislative wrangling and rhetoric, little changed this past year.
It is my job to listen to health-care consumers. They entered 2017 worried about the cost of coverage. They find themselves at the start of this year in the same place they ended the last. People want to know: What happened to the “affordable” part of the Affordable Care Act?
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Public health-care entitlements in the U.S. have traditionally been designed to supplement rather than to supplant privately purchased health insurance. About 40% of the entitlement funds disbursed under the Affordable Care Act (ACA), however, have gone to individuals who already had private coverage. This displacement of private-sector spending by public-sector activity is called “crowd-out.” While the ACA has reduced the share of the American population without health insurance, its spending has been poorly-targeted to fill gaps in care, and 28 million remain uninsured.
This paper reviews estimates of ACA crowd-out and examines the potential for block grants to allow states to target assistance at individuals otherwise lacking coverage. Under such a reform, the same level of federal funding could do more to expand access to care and to provide protection from catastrophic medical costs for those who need help the most.
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Americans are familiar with the horrors of the opioid crisis, and government at every level has tried to respond with spending on treatment programs and more. But one area that deserves more scrutiny is how government programs may be contributing to the epidemic.
Wisconsin Senator Ron Johnson released a report this month from the Senate Homeland Security and Governmental Affairs Committee that connects the dots between Medicaid and the opioid epidemic. The report doesn’t claim too much, conceding that everything from too many prescriptions to drug marketing contributed to the epidemic.
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Republican leadership emerged from their Camp David policy retreat earlier this month announcing that significant healthcare reform is not on their 2018 agenda. That’s bad news for the one-quarter of Americans who put off or postpone getting the healthcare they need each year because of its costs, which have doubled since 2013.
To meaningfully address these skyrocketing healthcare costs, bold reforms are needed. Rather than simplistic assertions that blame doctors, legislators must tackle healthcare’s stultifying bureaucracy consisting of federal and state government agencies, big insurance companies, and, yes, the American Medical Association.
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Legislation to expand Medicaid in Virginia failed Thursday after a state Senate panel voted on party lines to defeat the measure.
The state’s Education and Health Committee voted down the bill 8-7. The bill can be brought up at another time, but if the committee doesn’t take further action, the bill is dead.
The bill, sponsored by state Sen. Emmett Hanger (R), would have directed the state’s secretary of Health and Human Resources to submit a Medicaid expansion waiver to the federal government.
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- Health care is at the top of a group of issues that voters want 2018 midterm candidates to talk about, but it’s a much higher priority for Democratic voters (39 percent) and independent voters (32 percent) than Republican voters (13 percent); and a lower priority than other issues among voters living in areas where there are competitive 2018 House, Senate, or Governor races.
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GOP leaders from both chambers of Congress want reinsurance. But they want it in different ways.
And with two different Republican measures on the table, each handling the mechanics differently, the big question is: Which one will win out if congressional Republicans go through with their plan to address stabilization in an upcoming spending bill.
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The less-explored question involves why Obamacare’s overall combination of taxpayer subsidies, expanded insurance programs, health benefits requirements, AND coverage mandates had so much less of an effect than the law’s architects envisioned.
It turns out that many of the nominally uninsured still have other alternatives to health care than just through heavily-subsidized Medicaid and exchange-based insurance. You might call such uncompensated care either an option for “implicit insurance” or a hidden tax on acquiring more formal coverage.
Health policy researchers Amy Finkelstein, Neale Mahonem and Matthew Nolowidigdo unravel the puzzle in a recent National Bureau of Economic Research paper. They explain why there is less “demand” than expected for the increased “supply” of subsidized coverage for lower income individuals and more limited take up of subsidized coverage than once predicted.
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Republicans in Congress and the Trump administration failed to fulfill their commitment to repeal and replace the Affordable Care Act (ACA) in 2017, but they did succeed in repealing the tax penalties enforcing the law’s individual mandate, starting in 2019.
The GOP still might try again to fully repeal and replace the ACA in 2018, perhaps with a modified version of the Graham-Cassidy legislation. However, with Republicans now down to a 51-seat majority in the Senate and some House and Senate members facing difficult mid-term elections this November, it will be even more challenging to get a sweeping rollback of the ACA through Congress in 2018 than it was in 2017.
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