Monday Morning Medicaid Must Reads: June 11th, 2018

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


Article 1:  

Clay’s summary: Medicaid advocates may be acting foolish to oppose work requirements- a small group of people are affected, and it may be the grease that makes non-expansion states expand.

Key Passage from the Article

Recent proposals for redesigning this part of Medicaid have identified this pervasive issue: work and policymakers’ attitudes toward it. Most Americans under age 65 at all income levels receive health insurance through their employment and are induced (through tax breaks and employer regulations) to take it as part of their compensation. Several states, including some that reluctantly implemented expansion and some contemplating it, have asked for federal permission to link Medicaid eligibility to labor force participation—working or looking for work.

As with everything in health policy these days, this idea is controversial, with disagreement even about the facts but more fundamentally about subjective social values. The factual questions are 1. how many people on Medicaid would be affected by this policy and 2. how many people who receive Medicaid would be able to work (or go to school) if they are not already, and how many would just choose not to?

The value question deals with the latter group—if some of them could find employment, but choose not to, would you as a taxpayer be willing to sacrifice some of your wages to pay for their health insurance? There can be no doubt that some politicians and the citizens who support them say no, while others say yes. There is no generally accepted principle that can tell analysts that one value system is better than the other.

Read it here 

Article 2:   

Disrupt this: Jettison Medicare and Medicaid, Marilyn Singleton, MD, Daily Press, May 17, 2018

Clay’s summary: A Stanford Doctor tells us that government healthcare should be only for soldiers, and anything beyond that only increases costs and decreases quality.

Key Passage from the Article


The Great Society’s social engineers would not be satisfied until the government burrowed deeper into medical care. Thus Medicaid for all the “medically indigent” and Medicare for all seniors (aka middle class welfare) were born.

And since money grows on third-party and government trees, medical costs were ignored, and expenditures dramatically increased from 5.0 percent of GDP in 1960 to 17.9 percent in 2016. And at 28 percent, healthcare expenditures are the single largest piece of the federal budget pie.

The ACA’s justification for commandeering the remainder of the health insurance market was to rid our nation of the uninsured. Yet six years later, the nation’s uninsured dropped a mere 3.8 percent, and premiums have more than doubled. The number one reason the current uninsured did not buy insurance was because the cost was too high. Of course it was. The ACA’s mandated “free” benefits had to be paid for somehow. Worse yet, it now takes a Herculean effort to find individual health insurance; nationally, there are only 3.5 issuers in the ACA marketplace.

Medicare and Medicaid began the upending of the health insurance business. These programs became the siren call, enticing us to cede control over our health to disinterested third parties and middlemen. Government largesse led us to accept blind pricing as the norm. Where else do you buy something before you know what it costs? Freebies lured us into relinquishing our privacy to government data banks and now leave us longing for the comfort and simplicity of a computer-free doctor visit.


Read it here




Article 3:   

Medicaid and CHIP Scorecard, CMS, June 2018

Clay’s summary:

Key Passage from the Article

 What’s in the Scorecard?

Like Medicaid and CHIP beneficiaries, information in the Scorecard spans all life stages. This first version of the Scorecard includes information on selected health and program indicators. It also describes the Medicaid and CHIP programs and how they operate.

The Scorecard will evolve. Future iterations likely will allow year-to-year comparisons to help identify trends. The Scorecard will be flexible—CMS may add new areas of emphasis important to the Medicaid and CHIP programs or replace measures as more outcome-focused ones become available.

CMS worked with a subset of state Medicaid agencies to select measures for this first Scorecard. Many measures in the Scorecard come from public reports. For example, most measures in the State Health System Performance pillar come from the Child and Adult Core Sets. This approach allows CMS to align the Scorecard with existing reporting efforts.

Including measures from the Core Sets in the Scorecard builds on states’ investments in collecting and reporting these voluntary measure sets. While there are many reasons some states do not collect or report all Core Set measures, CMS hopes the Scorecard will draw attention to the importance of reporting on these measures. Core Set reporting methods also can vary among states. For example, some states have access to different data on populations covered under fee-for-service as compared to populations covered under managed care. This variation in data availability can impact measure performance. Readers should review the detailed measure notes located after the graph to better understand states’ reported rates.

The Scorecard also sheds light on important questions about the scope of Medicaid and CHIP. …



Read it here