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Monday Morning Medicaid Must Reads: July 31st, 2017

Helping you consider differing viewpoints. Before it’s illegal. 

 

Article 1:  Ron Johnson: Medicaid expansion may be fueling opioid crisis. Todd Shepherd, July 27, 2017. Washington Examiner

Clay’s summary: That pesky Republican Senator from Wisconsin makes some good points.

Key Passage from the Article

 Johnson’s letter did not draw a perfect causal link between the two by suggesting Medicaid is the prime driver of the opioid crisis. But it offered up enough case studies to suggest that the expansion since 2014 has contributed.

Johnson told the HHS inspector general that internal data from the agency showed that overdose deaths, “largely from opioids, are surging much faster in Medicaid expansion states than in non-expansion states.”

“The number of convictions for improperly using Medicaid to obtain opioids, identified through such a cursory search, suggests a larger systemic problem,” Johnson concluded. “Because opioids are so available and inexpensive through Medicaid, it appears that the program has created a perverse incentive for people to use opioids, sell them for large profits, and stay hooked.”

Read it here 


Article 2:  Medicaid Reform. Heritage Foundation, July 27, 2017

Clay’s summary: Lots of pesky facts in this one. My favorite – when asked how the feds should focus Medicaid spending, 56% of poll respondents say the focus should be on the elderly and disabled. 46% say it should be for income-based groups instead.

Key Passage from the Article

By changing the formula reimbursement, Obamacare incentivized the addition of able bodied adults to the Medicare rolls. Eighty-three percent of the increase in Medicaid enrollment during 2014–2016 occurred in states that adopted the Obamacare expansion of able-bodied adults. Over the 3-year period (2014, 2015, and 2016), Medicaid grew 14 million; of that, 11.7 million (83 percent of total growth) occurred in states who expanded Medicaid to able-bodied adults. The increased funding to this group means there is less money available for the original beneficiaries of Medicaid—elderly disabled, pregnant women, and children in poverty.

Read it here

 


Article 3:  His Wife Runs Medicaid, but This Doctor’s Practice Won’t Accept It. Phil Galewitz, The Daily Beast, July 27, 2017

Clay’s summary: The headline is clickbait, but the rest of it is a good look at how Medicaid can not draw critical provider types like child psychiatrists into the network.

Key Passage from the Article

 Members of the Trump administration and Republicans on Capitol Hill repeatedly say the country’s Medicaid system is “broken” and enrollees struggle to get care because many doctors refuse that coverage.


The top U.S. official overseeing Medicaid—Seema Verma—doesn’t have to look far to find an example. Her husband, Dr. Sanjay Mishra, is one of them.
Mishra is a child psychiatrist in Carmel, Ind., and a partner and medical director of Indiana Health Group, a large medical practice specializing in mental health. That group doesn’t accept Medicaid.


“It’s sadly ironic, but given what I know… I am not one bit surprised,” said Dr. J. Wesley Boyd, associate professor of psychiatry at Harvard Medical School, who co-authored a study this year on the struggles children enrolled in Medicaid face looking for care.


Verma is administrator of the Centers for Medicare & Medicaid Services and a former consultant who helped design Indiana’s Medicaid program.


Jane Norris, a CMS spokesman, said Verma’s husband does not accept Medicaid because that “helps avoid any further conflict of interest or complication of her recusal obligations.”

Read it here

 

 

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Monday Morning Medicaid Must Reads: July 10th, 2017

Helping you consider differing viewpoints. Before it’s illegal. 

 

Article 1: Has Medicaid Made the Opioid Epidemic Worse? The National Review, Sam Adolphsen, July 5, 2017

Clay’s summary: Heck yes, it has. Duh.

Key Passage from the Article

In 2015, the seven states with the highest drug-overdose death rates were West Virginia, New Hampshire, Kentucky, Ohio, Rhode Island, Pennsylvania, and Massachusetts. These states all have something else in common: All were among the 31 states (not including D.C.) that expanded Medicaid through Obamacare. Two questions must now be asked: Did expansion actually make the problem worse? And was Medicaid partly responsible for initiating the problem to begin with? Ohio, which has enrolled more than 700,000 adults in its Obamacare Medicaid expansion, is seeing worse problems with opioids than ever before. This year alone, the state is on pace for more overdose deaths than the entire United States had in 1990, according to an Ohio county coroner. It’s important to recognize that the problem ultimately stems from legal prescription drugs, not the illegal drug market — though many prescription-drug addicts do switch to heroin as a cheaper alternative. According to Andrew Kolodny, a Brandeis University senior scientist and the executive director of Physicians Responsible for Opioid Prescribing, “overprescribing of opioids is fueling the epidemic.” CDC data indicate that overdose deaths involving prescription opioids have quadrupled since 1999, and that prescription opioids now account for half of all opioid-overdose deaths.

 

Read it here 


Article 2: Democrats’ Fearmongering Over Medicaid Ignores Just How Bad the Program Is, The Daily Signal, Betsy McCaughey, July 5, 2017

Clay’s summary: In all the bravado about how Medicaid will be gutted, few are talking about the shame of the inferior nursing home care Medicaid pays for every day and has for decades. If anyone has been in a position to address the issue, Medicaid officials have- and its not enough to just say there’s not enough money.

Key Passage from the Article

Because even rudimentary infection prevention is lacking, one-quarter of residents pick up dangerous, drug-resistant bacteria, according to new research by Columbia University School of Nursing. Columbia’s Carolyn Herzig warns infection rates are increasing across the board and action is urgently needed.

Medicaid recently adopted new standards calling for more infection precautions, but delayed the start date to November 2019. Why delay when hundreds of thousands of elderly residents will die from infection in the meantime?

Don’t count on the media to cover these deaths. The Washington Post is busy claiming repeal “takes a sledgehammer to Medicaid.” The New York Times reports that “steep cuts to Medicaid” will force some seniors out of their nursing homes.

Here’s the truth: There are no “cuts.” Medicaid spending will continue to increase every year, though at a slower rate.

The real threat to seniors isn’t Medicaid funding levels. It’s that Medicaid officials tolerate substandard nursing home care, when they could use the program’s market clout to demand safer care. About 66 percent of long-term residents are paid for by Medicaid.

The federal government rates nursing homes from one to five stars, based on periodic inspections, staffing levels, infection rates, and other quality measures.

But even nursing homes that get the lowest one-star rating year after year—indicating substandard care—are allowed to stay open. They should be shut down.

Read it here

 


Article 3: How A Bogus Claim About Medicaid Made It Into The Los Angeles Times With No Pushback, The Federalist, Jonathan Ingram, July 5, 2017

Clay’s summary: Expanding Medicaid to more healthy adults came at the cost of reduced coverage for the most vulnerable in multiple states. Also- the MSM hides facts that might tarnish the optics on ACA? No way! Somebody should bodyslam those guys. But not DDT – that’s taking it too far.

Key Passage from the Article

While Ohio eliminated Medicaid eligibility for more than 34,000 seniors and individuals with disabilities, it was busy moving able-bodied adults to the front of the line under Obamacare. The expansion has been particularly tough on Ohio, where the Kasich administration promised the number of able-bodied enrollees would never exceed 447,000. By May 2017, expansion enrollment topped more than 725,000 individuals.

The result? Ohio’s Obamacare expansion has already run nearly $7 billion over budget, costing taxpayers nearly twice what was initially promised. The state’s share of those costs started coming due earlier this year, and those overruns are now crowding out funding for other state priorities like education, public safety, and services for the most vulnerable. In a state where Medicaid already consumes nearly half of the operating budget, cost overruns in the Obamacare expansion can easily lead to devastating cuts to other priorities.

This isn’t an isolated event, either. The enrollment explosion is happening in every state that expanded Medicaid under Obamacare. As a result, states are facing mounting costs far higher than they expected, forcing them to cut funding for other priorities or pass new tax hikes. Domenech was right when he remarked that Obamacare made able-bodied adults a top priority, crowding out funding for the most vulnerable. And he wasn’t lying when he said that more than 34,000 seniors and individuals with disabilities in Ohio were pushed out of Medicaid shortly after the expansion went into effect.

Read it here

 


Article 4: 

Clay’s summary: It’s getting harder to ignore the fact that organized crime is behind a lot of the bigger Medicaid frauds.

Key Passage from the Article

Fraud tends to cluster in certain areas and in certain treatment categories. The reason for that is that this fraud is not random, not just the result of some yahoo general practitioner in Eucheeanna padding his bills. It’s the work of organized crime. As Sparrow points out, when there is a criminal case filed against one of these fraud artists, then billing in a particular category — some years ago, it was HIV fusion treatments — falls off steeply, by as much as 90 percent. The implication here is that fraudulent billing may make up the majority of Medicaid and Medicare spending in some categories.

 

Read it here

 

 

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Monday Morning Medicaid Must Reads: July 3rd, 2017

Helping you consider differing viewpoints. Before it’s illegal. 

 

Article 1: Are Medicaid patients more likely to die than uninsured, as Heritage Action CEO says? Politifact, June 28th, 2017, Amy Sherman

Clay’s summary: I think most “fact-checking” sites (unfortunately including Snopes) have become pretty biased, but this is a decent article. Makes a good case for diving deeper on true impact of Medicaid on health outcomes. Too simple to say “Medicaid makes outcomes worse.” But also too simple to say “Millions will die without Medicaid.”

Key Passage from the Article

 

“This implication that somehow you get worse care with an insurance plan — Medicaid — than you would by not having an insurance plan at all — no coverage, just going to the ER for emergencies — for most reasonable people that doesn’t make any sense,” he said.

PolitiFact has previously found at least seven academic papers that detected a link between securing health insurance and a decline in mortality. In general, these papers present a stronger consensus that having insurance saves lives.

Harvard researchers recently wrote a piece summarizing the evidence on the effect of Medicaid or other insurance on mortality. Their review of the evidence concludes that insurance like Medicaid significantly reduces mortality relative to being uninsured, said Katherine Baicker, one of the authors. The researchers found that “coverage expansions significantly increase patients’ access to care and use of preventive care, primary care, chronic illness treatment, medications, and surgery. These increases appear to produce significant, multifaceted, and nuanced benefits to health.”

Read it here 


Article 2: Republicans are trying to undo Obama’s Medicaid disaster, NY Post, Besty McCaughey, June 27th, 2017

Clay’s summary: The idea that Medicaid today is not what it was ever intended to be is lost on most. Part of the reason is because we are such a wealthy nation we have lost all concept of what true poverty is. Today’s middle class now thinks of itself as poor.

Key Passage from the Article

Medicaid was created in 1965 as a safety net for the poor. But ObamaCare distorted it, edging the US health-care system closer to a Medicaid-for-all or single-payer system. Swelling the Medicaid rolls — instead of making private insurance affordable — was the main trick ObamaCare used to boost the number of insured.

A whopping 75 million people are now enrolled on Medicaid, 20 million more than in Medicare, the program for the elderly. If the repeal bill doesn’t pass, Medicaid enrollment will soar to 86 million by 2026, according to a Congressional Budget Office analysis released Monday.

Who’s picking up the tab for this vast Medicaid expansion? You. Worse, you pay twice — once as a taxpayer, then again as an insurance consumer.

Families with private insurance pay $1,500 to $2,000 or more in added premiums yearly already to keep Medicaid afloat. The more Medicaid expands, the higher their premiums will go.

That’s because Medicaid shortchanges hospitals and doctors, paying less than the actual cost of care. They make up for it by shifting the costs onto privately insured patients. Ouch.

That cost-shifting only works until Medicaid enrollment grows too large. The Mayo Clinic warned three months ago that Medicaid enrollment has reached the tipping point. The renowned clinic announced it will have to turn away some Medicaid patients, or put them at the back of the line, behind patients with private insurance.

 

Read it here

 


Article 3: Veterans Helped By Obamacare Worry About Republican Repeal Efforts, NPR, Stephanie O’Neill June 28, 2017 

Clay’s summary: I recently learned that vets have to pay premiums for their healthcare. And I am still angry about that so hard for me to summarize this article. Can we make their care free before we cover everyone else in Medicaid?

Key Passage from the Article

There are about 22 million veterans in the U.S. But less than half get their health care through the Veterans Affairs system; some don’t qualify for various reasons, or may live too far from a VA facility to easily get primary health care there.

Many vets instead rely on Medicaid for their health insurance. Thirty one states and the District of Columbia chose to expand Medicaid to cover more people — and many of those who gained coverage are veterans.

The GOP health care bill working its way through the Senate would dramatically reduce federal funding for Medicaid, including rolling back the expansion funding entirely between 2021 and 2024.

Medicaid coverage recently has become especially important to Ramos — a routine checkup and blood test this year showed he’s infected with hepatitis C. California was one of the states that chose to expand Medicaid, and the program covers Ramos’ costly treatment to eliminate the virus.

“Right now, I’m just grateful that I do have it,” he says. “If they take it away, I don’t know what I’m going to end up doing.”

Read it here

 


Article 4: Cardiac Arrests Dropped Under Obamacare Medicaid Expansion, Forbes, Tara Helle, June 29, 2017

Clay’s summary: There are clearly specific procedures and conditions improved by having easier access to care. Can we focus on those?

Key Passage from the Article

Cardiac arrests among previously uninsured middle-aged adults dropped by 17% after they got insurance through the Affordable Care Act, or Obamacare, a new study shows. The incidence of cardiac arrests remained the same among adults age 65 and older, a group that had consistently high rates of health insurance coverage before and after the ACA, primarily through Medicare.

“The fact that was this decrease was not observed in the elderly, who have near-universal access to healthcare, makes the availability of insurance one of the likely causes of the drop in cardiac arrest rate,” said lead author Eric Stecker, MD, MPH, an associate professor of cardiology at Oregon Health & Science University in Portland. “This study reinforces the results of prior studies which have shown that pretty consistently giving access to insurance significantly improves engagement in preventive care.”

Read it here

 


Article 5: Why the fear-mongering on Medicaid is totally overblown, Washington Post, June 28th, 2017

Clay’s summary: You might want to put down your Andy Slavitt, Michael Moore, and KFF Foundation echo-chamber devices (twitter feeds) before reading this one. And if they find out you read this one, you’re totally kicked out of the #Resist club.

Key Passage from the Article

A recent New York Times op-ed from three health-care experts described the effort as a “direct attack on our elderly, our disabled and our dignity.” A Post commentary charged lawmakers with “gutting Medicaid so they can give a giant tax break to their billionaire buddies,” threatening life-saving treatments for a young boy with a congenital heart condition. A long-time political adviser charged on national television that sponsors would “kick some kid out of his wheelchair.” And a left-leaning think tank further upped the ante by publishing contrived estimates of the numbers of people (handily broken down by state) who will supposedly be killed by the proposed legislation.

You don’t need to support the pending health-care bills to recognize they bear little resemblance to this explosive rhetoric, nor do you have to support the legislation to realize that our deteriorating political environment is making it impossible to make policy decisions with the appropriate reflection and care.

 

 

Read it here

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Menges Group 5 Slides Series for March and April 2017

The Menges Group puts out these great analyses and insights each month. And is kind enough to let us repost them for the MM audience. Check out themengesgroup.com to learn more about the work they do. 

Attached are the March and April 2017 editions of the 5 Slide Series.  The March edition tabulates the progression in Medicaid spending from 2012 – 2016, nationwide and with subtotals for states that did and didn’t adopt Medicaid expansion.  One key statistic from this edition is that capitation rose from 25.7% of all Medicaid spending in 2012 to 48.7% in 2016 – the capitated model will likely represent the majority of Medicaid spending from 2017 forward.

 

The April edition provides Medicaid MCO financial performance statistics for 2015 – a compilation of 199 MCO financial statements.  Collectively the industry earned a 2.4% operating margin on Medicaid business during 2015 with 71% of the MCOs achieving a positive margin and 29% experiencing a loss.  An interesting finding was that the health plans’ percent operating margins were not correlated with plan size.

March 2017, Medicaid Expenditure Trends 2012-2016

April 2017, Medicaid MCO Financial Performance Overview, 2015

 

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Monday Morning Medicaid Must Reads: June 19th, 2017

Helping you consider differing viewpoints. Before it’s illegal. 

 

Article 1: Nevada May Become First State To Offer Medicaid To All, Regardless Of Income, Alison Kodjak, NPR June 13, 2017 

Clay’s summary: I think SprinkleCare is political posturing that appeals mainly to those who know very little about CAID – but its getting dreamers excited, so maybe I’m the one who doesn’t know so much.

Key Passage from the Article

Under the proposal, Medicaid coverage would be offered alongside commercial insurance on Nevada’s state-run health exchange starting in 2019. Sprinkle says he’s not sure what the coverage would cost. The state would conduct an analysis of the Medicaid program to determine the size of premiums.

They would likely be lower than traditional insurance premiums, because Medicaid reimburses doctors less than most insurance plans and also pays lower prices for prescription drugs.

“If the expansion goes away, I really think this is going to be a viable option for those who lose coverage,” Sprinkle says. He estimates about 300,000 Nevadans may enroll.

He says that if the Republican health care bill becomes law, people could use the tax credits in the bill to buy into Medicaid. And if it doesn’t, they could still use their tax credits and subsidies from the Affordable Care Act, or Obamacare, to buy in.

To be able to sell policies on the exchange, Nevada would have to get approval from the Centers for Medicare and Medicaid Services in the form of a waiver. Sprinkle says he has had discussions with CMS officials who were open to the idea.

 

Read it here 


Article 2: Medicaid expansion to cost states nearly $9 billion, Kimberly Leonard, Washington Examiner, June 15, 2017

Clay’s summary: When budgeting for Medicaid expansion, go ahead and double whatever proponents say it will cost. Triple it for any estimates beyond 5 years. Some of this is because states paid nothing up until this year, some of it is because the per member costs of expansion members was were woefully underestimated.

Key Passage from the Article

State spending for Medicaid expansion under Obamacare is expected to reach $8.5 billion in 2018, a $4 billion increase from 2016, according to a national report released Thursday.

The report, assembled annually by the National Association of State Budget Offices, or NASBO, shows that median general fund spending on Medicaid grew 2.7 percent in fiscal 2016 and is estimated to grow at 5.2 percent in fiscal 2017. That outpaces growth in median general fund revenue, which reached 2.4 percent in fiscal 2016 and 2.5 percent in fiscal 2017.

 

Read it here

 


Article 3: Willowbrook, the institution that shocked a nation into changing its laws, Matt Reimann, Timeline, June 14, 2017

Clay’s summary: Our colleagues in the Caid and general health space who fought to end places like Willowbrook did the Lord’s work. I think they are on par with Abolitionists.

Key Passage from the Article

The Willowbrook State School opened on October, 1947, admitting 20 mentally disabled patients from upstate institutions. In only a short time, Willowbrook was overfilled and understaffed. By 1955, it had reached its full capacity of 4,000 occupants. Around that time, hepatitis infections ran rampant among patients and staff. Only a short time later, in 1960, an outbreak of measles killed 60 patients.
Yet these snapshots fail to convey the wretched and abhorrent conditions Willowbrook patients lived under. Despite its name as a “school,” there was barely any educational structure at Willowbrook. When teaching did happen, it was only for a handful of cooperative students, and only for around two hours per day.

Most of the Willowbrook experience was defined by constant neglect, a condition that the overstressed and underfunded staff were not necessarily responsible for. In some buildings, the mentally disabled were let to huddle in rooms, moaning, fidgeting, meandering, all with little care or resources. Many went naked for lack of clothing and supervision. Others sat drenched in their urine and feces, and some smeared them on the walls and on their clothes, with no available garments to replace them. Sexual and physical abuse at the hands of fellow patients and employees was common, as was disease.

Read it here

 

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Monday Morning Medicaid Must Reads: June 12th, 2017

Helping you consider differing viewpoints. Before it’s illegal. 

 

Article 1: Federal judge weighing whether Illinois must prioritize paying Medicaid bills, Chicago Tribune, Kim Geiger, 6/6/2017

Clay’s summary: IL Medicaid providers have been hung out to dry and are owed $2B. But hey expansion saves money, puppies and the environment, right? Also- Illinois budgeting and politics is a special kind of crazy.

Key Passage from the Article

 

A federal judge heard arguments Tuesday over whether Comptroller Susana Mendoza should be required to prioritize payments to some Medicaid providers among Illinois’ billions of dollars in unpaid bills that keep piling up during the state budget stalemate.

The court dispute reflects the mounting difficulty of balancing Illinois’ competing financial obligations in the midst of an ongoing political fight between Republican Gov. Bruce Rauner and Democrats who control the General Assembly.

Judge Joan Lefkow indicated in court on Tuesday that she was sympathetic to the complaints of the Medicaid patients, but that she was unlikely to go as far as telling the comptroller which bills should be set aside in order to make the payments.

 

 

Read it here 


Article 2: How Much Will The GOP’s Medicaid Per-Capita Cap Save, If Anything? CBO Refuses To Say, Forbes, Avik Roy, 6/8/2017

Clay’s summary: Block granting Medicaid may not save anything at all – but its an important Boogeyman for leftie fear-mongers to trot out when scaring-up the masses against AHCA.

Key Passage from the Article

 

CBO identifies three provisions in the AHCA that drive the $834 billion in reduced Medicaid spending. The first is the AHCA’s repeal of Obamacare’s Medicaid expansion. The second is its repeal of Obamacare’s individual mandate, which the CBO implausibly believes will lead more than 5 million people to drop out of Medicaid. The third is the per-capita cap reform of the pre-Obamacare Medicaid program.

Remarkably, and unusually, the CBO has decided not to break out the relative effects of these three provisions onto the Medicaid reform: a silence that has led to massive confusion among states who falsely believe that their traditional Medicaid programs will be subject to massive cuts.

CBO appears to believe that it’s too complicated to tease out the impact of the AHCA’s various provisions on Medicaid, because they interact with each other. But CBO does analyses of interacting provisions all the time.

This is all we know about the CBO’s view of the impact of per-capita caps: that they will “reduce outlays.” But the essential question is: by how much?

Read it here

 


Article 3: Michigan: Medicaid expansion producing big savings, Detroit News, Jonathan Osling, 6/5/2017 

Clay’s summary: It’s all fun and games until you have to be the one paying for it. Cue squishy savings theories to help skirt the previously agreed upon exit strategy.

Key Passage from the Article

Gov. Rick Snyder’s administration wants to broaden the equation used to calculate state savings from expanded Medicaid eligibility as it works to protect the Healthy Michigan plan from a potential demise. The 2013 Michigan law includes a trigger that would end expanded eligibility for the low-income health insurance coverage if state costs outweigh savings that result from federal funding . . . But the administration is disputing projections that the cost-savings trigger could put the program on the chopping block regardless of what happens at the federal level, arguing state savings go beyond traditional budget lines. . . “If you look at savings in uncompensated care and other savings that are out there, I don’t think that would sunset this particular plan,” Pscholka said. “I think you have to look at all the savings that are taking place with hospitals and everywhere else. That number is pretty large.”

Read it here

 

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3 Great New Analyses from Milliman

Our friends at Milliman have just released 3 new helpful analyses for the Medicaid space:

ACA Infographic- Showing how much individuals in each state benefit from exchange subsidies.  Its a pretty nifty graphic showing states in different heights based on enrollment. Also shows percentage of individuals receiving subsidies for each state, based on 2017 data. This infographic also touches on CSRs and average premiums. Its a lot of info packed into one map, and well worth the read.

ACA_CSRs Infographic-  This one gets into more specifics on the cost-sharing reduction payments you’ve seen in the news lately.

Reinsurance and High Risk Pools– This new discusses the following issues:

· Historical role of high risk pools in the pre-ACA market
· ACA’s transitional reinsurance program
· 1332 State Innovation Waivers and the development of state-run reinsurance programs
· Key considerations for high risk pools and reinsurance programs under pending healthcare reform legislation

I linked a copy above, and you can also find the original with more info on the authors here: http://us.milliman.com/insight/2017/Reinsurance-and-high-risk-pools-Past–present–and-future-role-in-the-individual-health-insurance-market/

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Monday Morning Medicaid Must Reads: June 5, 2017

Helping you consider differing viewpoints. Before it’s illegal. 

 

Article 1: FACT CHECK: Does The Trump Budget Gut Medicaid? Daily Caller, David Sivak, 5/30/2017

Clay’s summary: Maybe the sky is not falling.

Key Passage from the Article

What many refer to as “cuts to Medicaid” are actually cuts to the growth of Medicaid, not the current size of the program. The Trump administration allocates more for Medicaid every year of the budget. Director of the Office of Management and Budget Mick Mulvaney calls the misconception “a classic example of how Washington speaks differently than the world back home.”

Critics counter that despite increased spending in the budget, the size of Medicaid shrinks over time as a percentage of GDP, a measure of the size of the economy, dropping from two percent today to 1.7 percent in 2027.

While this is true, when looking at the size of Medicaid as a percentage of the total budget, it remains, on average, about the same size – 9.6 percent of the total budget – compared to 2016 funding levels. For this reason, it’s misleading to characterize the savings as cuts to Medicaid.

Read it here 


Article 2: Medicaid efficiency is needed now, more than ever The Hill, Bill Lucia 5/31/2017

Clay’s summary: New TPL legislation could help prevent improper payments when there is coverage besides Medicaid. Also, cool to see Bill Lucia publishing.

Key Passage from the Article

 

Unfortunately, some liable third parties have found loopholes in laws and regulations that shift costs to Medicaid. HR 938 aims to close these loopholes and ensure that the right party is paying the right claims. Among the key provisions in the Medicaid Third Party Liability Act that will result in Medicaid savings and efficiency are:

Prevents liable parties from denying claims due to a lack of prior authorization, thereby shifting these costs to Medicaid.
Gives Medicaid Managed Care Organizations (MCOs) the same rights as state Medicaid agencies to be the payer of last resort. This is important as nearly 70 percent of Medicaid recipients are currently enrolled in Medicaid managed care plans.
Replicates prompt payment standards routinely enforced in the commercial sector, but for Medicaid reclamation claims. These are claims for the recovery of payments made by Medicaid that are actually the responsibility of another healthcare program or liable insurer.

 

Read it here

 


Article 3: CMS chief: Medicaid needs reform, House healthcare bill ‘outdated’, McKnights, Emily Mongan, June 1, 2017

Clay’s summary: CMS Chief Verma is strategic in her view of the current funding fights. And she knows that CBO numbers are historically garbage.

Key Passage from the Article

Verma also dismissed the Congressional Budget Office’s cost estimate for the House’s healthcare proposal, noting “CBO numbers have historically been problematic” and that her focus has turned to the Senate’s version of the legislation. The CBO report estimated the bill could cut Medicaid funding by $834 billion over ten years, and leave 23 million people without health coverage by 2026.
“I’ve been working with a lot of the senators. We want to make sure that the president’s core principles are incorporated into the final version,” Verma said. “I think what’s more important is what the Senate comes up with. Really, the House version is something that’s outdated at this point.”

Read it here

 


Article 4: Medicaid’s Cracked Halo, Forbes, Sally Pipes, May 30, 2017

Clay’s summary: Forbes continues to write articles about Medicaid that no liberal wants to read. Or acknowledge that there is some truth to.

Key Passage from the Article

A recent issue brief from the Kaiser Family Foundation, meanwhile, concludes, “Medicaid is cost-effective.”

But the data tell a different story. Medicaid is a budget-busting program rife with waste, fraud, and abuse that doesn’t even expand access to quality care or improve health outcomes.

For starters, Medicaid’s costs are spinning out of control. In 2015, total Medicaid spending shot up almost 10 percent. Overall national health spending, by contrast, climbed only 5.8 percent. Last year, the Congressional Budget Office had to raise its projections for the 10-year cost of Medicaid by $146 billion, as per-enrollee costs came in far higher than expected.

Medicaid now accounts for 19 percent of states’ general fund spending. It’s their second-biggest budget line item, after education.

States across the country are facing budget crises this year, largely because of ballooning Medicaid costs.

Read it here

 


Article 5: AIS Survey Data Show Significant Growth in Medicaid Managed Care, AIS Health, Lauren Kelly, April 27, 2017

 

Clay’s summary: Medicaid managed care enrollment is up and its not just because of expansion.

Key Passage from the Article

Medicaid expansion is one explanation for increases in a few states, but many Medicaid expansion programs have been in force for several years, so it is not a factor in year-over-year growth for all expansion states. Numbers are up in several non-expansion states, including those without managed care, and slight decreases are seen in both expansion and non-expansion states.

Read it here

 

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A Few Charts re AHCA and Medicaid

These are from recent analyses and talks I have given on what to expect with AHCA. All info being updated as it comes in.

Gist is that AHCA seems to be a cut to growth, not a cut to actual spending. All CBO estimates are compared to current law (ACA) projections for future years.

Links to actuarial report used for 2014-2022 under ACA is below. So is link for CBO report.

Could be lot I am missing on this, but trying to piece together as best as I can. If you see any errors, please let me know using clay@mostlymedicaid.com.

 

Offered without commentary (for now)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

hr1628aspassed CBO report

medicaid-actuarial-report-2013  (actually from 2013, so ACA spending higher than shown. I was too lazy to update the projections for ACA, but realize the actuals came in much higher than this report projected, esp in 2016).