Medicaid Expansion and the Uninsured

Report: Medicaid expansion reduces uninsured patients, By Jesse Balmert, October 23, 2014, Marion Star: “With more people insured by Medicaid, several hospitals are treating fewer uninsured patients and paying less for charity care, according to a Policy Matters Ohio report released Tuesday. That’s good news for Ohio’s poor — especially those without children — and Gov. John Kasich, who spent Monday explaining to reporters that he supported Medicaid expansion while opposing the larger law it’s attached to — the Affordable Care Act, also known as Obamacare…”

Medicaid Expansion – Mississippi

Health advocates decry lack of Miss. Medicaid expansion, By Emily Wagster Pettus, October 7, 2014, Jackson Clarion-Ledger: “Groups supporting low-income Mississippi residents said Tuesday that elected officials are ignoring 300,000 people and refusing billions of federal dollars by choosing not to expand Medicaid in one of the poorest states in the nation. If the state were to extend Medicaid, as allowed under the health overhaul that President Barack Obama signed into law, many low-wage workers could receive coverage that would enable them to afford doctors’ visits, prescriptions and medical supplies, said Roy Mitchell of the Mississippi Health Advocacy Program…”

Medicaid Expansion for Children – Texas, Florida

Texas and Florida did expand Medicaid — for kids, By Phil Galewitz, September 29, 2014, USA Today: “Republican lawmakers in Florida and Texas snubbed the Affordable Care Act’s Medicaid expansion for adults, but their states did broaden the program this year — for school-age children. Those states were among 21 — including some big Democrat-led states, such as California — that were required to widen Medicaid eligibility for children between the ages of 6 and 18 by 2014. That little-known provision of the health law was one factor helping 1.5 million kids gain coverage in the state-federal health insurance program for the poor, according to a survey of a dozen states by Kaiser Health News…”

Hospitals and Medicaid Expansion

  • Hospitals see major drop in charity care, September 24, 2014, The Tennessean: “The number of uninsured patients admitted to hospitals has dropped markedly this year, reducing charity care and bad debt cases, particularly in states that have expanded Medicaid coverage under the new federal health care law, a government report released Wednesday found. The report from the Department of Health and Human Services said hospitals in states that have taken advantage of new Medicaid eligibility levels have seen uninsured admissions fall by about 30 percent. The report estimated that the cost of uncompensated hospital care will be $5.7 billion lower in 2014…”
  • Affordable Care Act reduces costs for hospitals, report says, By Robert Pear, September 24, 2014, New York Times: “The Obama administration increased the pressure on states to expand Medicaid on Wednesday, citing new evidence that hospitals reap financial benefits and gain more paying customers when states broaden eligibility. In states that have expanded Medicaid, the White House said, hospitals are seeing substantial reductions in ‘uncompensated care’ as more patients have Medicaid coverage and fewer are uninsured…”

Health Insurance Coverage in the US

  • 42 million people lacked health insurance in 2013, Census Bureau says, By Guy Boulton, September 16, 2014, Milwaukee Journal Sentinel: “An estimated 42 million people, or 13.4% of the population, were without health insurance coverage for all of 2013, according to the U.S. Census Bureau. The percentage was much higher for adults between 19 and 64 years old, with 18.5%, or almost one in five, uninsured last year. The estimates released Tuesday by the Census Bureau will become the baseline to track changes in the number of people who gain health insurance because of the Affordable Care Act. The parts of the law that will expand insurance coverage did not kick in until this year and are not reflected in the 2013 data…”
  • Number of Americans without health insurance falls, survey shows, By Sabrina Tavernise, September 16, 2014, New York Times: “Federal researchers reported on Tuesday that the number of Americans without health insurance had declined substantially in the first quarter of this year, the first federal measure of the number of uninsured Americans since the Affordable Care Act extended coverage to millions of people in January. The number of uninsured Americans fell by about 8 percent to 41 million people in the first quarter of this year, compared with 2013, a drop that represented about 3.8 million people and that roughly matched what experts were expecting based on polling by private groups, like Gallup. The survey also measured physical health but found little evidence of change…”

Medicaid Expansion – Virginia

With Medicaid expansion blocked, McAuliffe unveils modest plan to insure more Virginians, By Laura Vozzella and Jenna Portnoy, September 8, 2014, Washington Post: “Gov. Terry McAuliffe (D), who vowed in June to defy the Republican-controlled legislature and expand healthcare to 400,000 uninsured Virginians, unveiled a much more modest plan Monday after being thwarted by federal rules and a last-minute change to state budget language. McAuliffe outlined measures to provide health insurance to as many as 25,000 Virginians, just a fraction of those he had hoped to cover by expanding Medicaid under the Affordable Care Act…”

Hospitals and Medicaid Expansion

  • Report: Hospitals in Medicaid-expansion states performing well, By Chelsea Keenan, September 8, 2014, Cedar Rapids Gazette: “Hospitals in states that expanded Medicaid are seeing higher revenues and a reduction in uninsured patients, according to a new report by PwC’s Health Research Institute. The report analyzed financial data from the country’s five largest for-profit health systems, which represent 538 hospitals in 35 states. ‘There were lots of debates in (Washington) D.C. around these issues,’ said Gary Jacobs, a managing director at PWC. ‘There were lots of promises and good intentions. But the jury was still out on how it would shape up.’ The growth in the 26 Medicaid expansion states and Washington, D.C., starkly contrasts the experience in the 24 states that did not expand the program, the report found…”
  • Hospital officials frustrated with financial losses since state did not expand Medicaid, By Shannon Muchmore, September 8, 2014, Tulsa World: “Tulsa hospital executives are frustrated at losing out on reimbursements because of what they say are purely political decisions. Hospitals in Oklahoma are projected to lose more than $4 billion in reimbursements between 2013-22 because the state chose not to expand Medicaid, according to a recent report by the Urban Institute…”

States and Medicaid Expansion

  • States that decline to expand Medicaid give up billions in aid, By Tony Pugh, September 2, 2014, The State: “If the 23 states that have rejected expanding Medicaid under the 2010 health care law continue to do so for the next eight years, they’ll pay $152 billion to extend the program in other states – while receiving nothing in return. This massive exodus of federal tax dollars from 2013 through 2022 would pay 37 percent of the cost to expand Medicaid in the 27 remaining states and Washington, D.C., over that time. Most of the money, nearly $88 billion, would come from taxpayers in just five non-expansion states: Texas, Florida, North Carolina, Georgia and Virginia. The findings are part of a McClatchy analysis of data from the Urban Institute, a nonpartisan research center that’s advised states on implementing the health care law, the Affordable Care Act…”
  • NC’s $10 billion Medicaid challenge: Pay for other states or take federal money?, By Ann Doss Helms and Tony Pugh, September 2, 2014, Charlotte News and Observer: “North Carolina taxpayers could spend more than $10 billion by 2022 to provide medical care for low-income residents of other states while getting nothing in return, a McClatchy Newspapers analysis shows. The federal health law tried to expand Medicaid to millions of low-income, uninsured adults. But many Republican-led states, including North Carolina, opted out of the plan championed by President Barack Obama…”

ACA Coverage

  • Reports: ACA coverage reached more than 9 million, By Kaitlyn Krasselt, July 15, 2014, USA Today: “Far more people are insured because of the Affordable Care Act than the White House estimated in May, new research shows. At least three new studies on the ACA’s effect show big increases in the number of newly insured Americans, with the highest estimate topping out at 9.5 million from the Commonwealth Fund. That compares with the 8 million reported by the White House in May. It’s hardly all good news for the administration’s efforts, however. Analysts from the Rand Corporation estimate that while 14.5 million people gained coverage in the last year, about 5 million people were insured before the ACA and lost coverage because of the law — leading to a net gain of around 9 million. . .”
  • Groups under Health Act are said to aid millions, By Abby Goodnough, July 15, 2014, New York Times: “More than 4,400 consumer assistance programs created under the Affordable Care Act helped an estimated 10.6 million people explore their new health insurance options and apply for coverage during the initial six-month enrollment period, according to a new Kaiser Family Foundation survey. But the programs that operated in states with their own online insurance marketplaces got more funding and helped more people than those in states on the federal exchange, the survey found. In the District of Columbia and 16 states that ran or were working toward running their own exchanges, the programs helped about twice as many people, relative to the uninsured population, as they did in 29 states served by the federal exchange. . .”

Part-Time Work

  • A part-timer boom, or blip? By Robert Samuelson, July 16, 2014, Washington Post: “There may be a dark lining to the sunny June employment report, which recorded an increase of 288,000 payroll jobs for the month. Most — or all — of the increase may have been part-time jobs. If that’s a trend, it could signal a weaker economy. It could also vindicate critics of the Affordable Care Act (the ACA or Obamacare). They have argued that the added costs of providing health insurance for full-time workers would cause many firms to emphasize part-time employment. Is it a trend? Writing in the Wall Street Journal, Mortimer Zuckerman — real estate developer and editor in chief of U.S. News & World Report — says yes. Some data seem convincing. In June, part-time jobs (defined as less than 35 hours a week) increased by 1,115,000, reports the Bureau of Labor Statistics (BLS); full-time jobs fell by 708,000. . .”
  • Yes, some people are working part-time. No, that’s not a disaster for the recovery. By Jared Bernstein, July 18, 2014, Washington Post: “By many indicators, the recent job market is clearly improving. It still has a long way to go, but the pace of employment growth is up and unemployment has fallen sharply in recent months. Importantly, the recent decline in the jobless rate has been for the right reason: people getting jobs as opposed to people leaving the labor market (since only jobseekers are counted as unemployed, if they give up the job search, the unemployment rate is artificially lowered). Still, those in the business of disparaging the ‘Obama recovery’ latched onto the spike in part-time work in the last jobs report as an indicator that the silver lining has a dark cloud around it. Based on the rise in part-time jobs in June, a Wall Street Journal opinion piece complained. . .”
  • Part-Time Workers Deserve the Shift, Not the Shaft, By Megan McArdle, July 17, 2014, Bloomberg View: “The plight of low-wage retail workers has generated much talk in recent years. As I’ve written before, I don’t find problematic the existence of jobs that do not pay enough to support a family. Retail jobs have never paid well, because retail margins tend to be pretty slim. The problem is not that retail is a low-wage job, but that an increasing number of people can’t find any other sort of job. The natural response of many people is to say, well, these are the jobs we have now, so they should pay what factory jobs used to. Yet like the manufacturing jobs that went away, many of those low-wage retail jobs also face competition — from higher-productivity firms. . .”

Medicaid Enrollment

Millions enrolling into Medicaid, now what? By Lisa Bernard-Kuhn, June 26, 2014, Cincinnati Enquirer: “In the coming days Charles McClinon will learn whether he’s a candidate for a potentially lifesaving surgery, a procedure the 50-year-old epileptic says is finally an option for him thanks to expanded Medicaid benefits in Ohio. ‘I’m so hopeful now,’ said the Roselawn resident, who four years ago suffered a serious fall during a seizure that sent him to the emergency room and then into the spiral of medical morass that eventually cost him his job, health insurance and Chicago home. ‘I had always been a very highly functional person living with epilepsy, but after the fall, my seizures had gotten so bad, I just didn’t have the strength and awareness to fight,’ said McClinon. Across the U.S., millions of Americans are tapping into newly available Medicaid benefits. Some, like McClinon, say the coverage offers the chance . . .”

ACA Sign-up Period

Study: Selling health insurance at Christmas is bad idea, By Louise Radnofsky, June 26, 2014, Wall Street Journal: “Tax preparers and some other advocates have complained for a while that the health law’s insurance sign-up period is timed wrong. Now they have a paper in the journal Health Affairs to back them up. Asking lower-income people to contemplate buying coverage around the holiday season is a bad idea, because their decision-making capacity is stretched too thin, say two health policy professors. Crafters of the Affordable Care Act originally envisaged the open enrollment period as a fall activity that would coincide with the sign-up periods for Medicare and also the time when many Americans who get coverage through their jobs have to renew their elections. . .”

Health Care Exchanges

Competition heats up on health care exchanges for 2015, By Jayne O’Donnell and Kaitlyn Krasselt, USA Today: “Insurance companies are gingerly moving onto health care exchanges in some competition-deprived states, and they are requesting rate increases that are largely in line with pre-Obamacare years, state filings show. A few big and many smaller insurers avoided the 2014 state- and federal-run health care exchanges that sold individual insurance plans as required under the new law. Some blame these insurer absences for higher rates than many people expected under the Affordable Care Act, but that’s likely to change for the 2015 plan year, experts say. ‘There’s a lot more competition now than there was prior to the advent of the ACA . . .”

Medicaid Expansion

  • In Texarkana, uninsured and on the wrong side of a state line, By Annie Lowrey, June 8, 2014, New York Times: “On a hazy, hot evening here, Janice Marks ate a dinner of turkey and stuffing at a homeless shelter filled with plastic cots before crossing a few blocks to the Arkansas side of town to start her night shift restocking the dairy cases at Walmart. The next day, David Tramel and Janice McFall had a free meal of hot dogs and doughnut holes at a Salvation Army center in Arkansas before heading back to their tent, hidden in a field by the highway in Texas. None of the three have health insurance. But had Ms. Marks, 26, chosen to sleep on the side of town where she works, or had Mr. Tramel and Ms. McFall, who are both in their early 20s, made their camp where they had eaten their dinner, their fortunes might be different. . .”
  • Long waits persist for those applying for Medicaid coverage in many states, By Phil Galewitz, June 7, 2014, Washington Post: “While an unprecedented 6 million people have gained Medicaid coverage since September, mostly as a result of the Affordable Care Act, more than 1.7 million more are still waiting for their applications to be processed — with some stuck in limbo for as long as eight months, according to officials in 15 large states. The scope of the problem varies widely. California accounts for a lion’s share of the backlog with 900,000 applications pending as of early June. The next-biggest pileup is in Illinois, with 283,000 cases, while New York has no backlog at all. All three states have implemented the health law’s expansion of Medicaid . . . “

Medicaid Enrollees

Cook County releases 1st snapshot of new Medicaid patients, By Peter Frost, June 2, 2014, Chicago Tribune: “New data released in May offer the first look at the health, habits and demographics of about 100,000 new enrollees in Cook County’s expanded Medicaid program under the Affordable Care Act. The picture it paints is bleak. More than half the new patients covered by Cook County’s Medicaid expansion program haven’t seen a doctor in the past 12 months. Eighty-five percent of them are unable to obtain needed medications. Nearly one-fourth have spent time in a hospital in the past six months and an additional 1 in 5 are worried about finding a place to stay in the near future. They suffer from heart disease, high cholesterol. . .”

State Medicaid Expansion

  • Medicaid surge triggers cost concerns for states, By Ricardo Alonso-Zaldivar, May 26, 2014, Associated Press: “From California to Rhode Island, states are confronting new concerns that their Medicaid costs will rise as a result of the federal health care law. That’s likely to revive the debate about how federal decisions can saddle states with unanticipated expenses. Before President Barack Obama’s law expanded Medicaid eligibility, millions of people who were already entitled to its safety-net coverage were not enrolled. Those same people are now signing up in unexpectedly high numbers, partly because of publicity about getting insured under the law. . .”
  • Hearings set for Healthy Indiana Plan expansion, By Associated Press Staff, May 25, 2014, Miami Herald: “Two public hearings are scheduled this week on Gov. Mike Pence’s plan to use Medicaid funds to expand the Healthy Indiana Plan to provide insurance under the federal health care overhaul. The Family and Social Services Administration said the hearings will be held Wednesday and Thursday on the state government campus in downtown Indianapolis. Wednesday’s hearing begins at 9 a.m. in Conference Center Room B at the Indiana Government Center South. Thursday’s begins at 1 p.m. in Room 156-B at the Statehouse. The FSSA also announced Friday that it has posted a draft of the proposed Medicaid waiver to pay for the HIP expansion and other related documents on the Healthy Indiana Plan website at http://www.hip.in.gov/ . . .”

Safety Net Hospitals

An Obamacare winner: Safety-net hospitals, By Phil Galewitz, May 24, 2014, USA Today: “At Seattle’s largest safety-net hospital, the proportion of uninsured patients fell from 12% last year to an unprecedented low of 2% this spring — a drop expected to boost Harborview Medical Center’s revenue by $20 million this year. The share of uninsured patients was cut roughly in half this year at two other major safety net hospitals — Denver Health in Colorado and the University of Arkansas for Medical Sciences Hospital (UAMS) in Little Rock. One of the biggest beneficiaries of the health law’s expansion of coverage to more than 13 million people this year has been the nation’s safety-net hospitals. . .”

Medicaid Patient Health

Poorer Health of Surgery Patients on Medicaid May Alter Law’s Bottom Line, By Robert Pear, May 17, 2014, New York Times: “Surgery patients covered by Medicaid arrive at the hospital in worse health, experience more complications, stay longer and cost more than patients with private insurance, a new study has found. The study, by researchers at the University of Michigan, may offer a preview of what to expect as millions of uninsured people qualify for Medicaid under the Affordable Care Act. Although Medicaid patients in the study were generally younger than the privately insured patients, they were twice as likely to smoke and had higher rates of conditions that made surgery riskier. Those conditions, which can arise from years of poor health habits, include diabetes, lung disease and blood vessel blockage. . .”

ACA and Medicaid Expansion

  • Medicaid’s new patients: healthier, and maybe cheaper, By Dan Gorenstein, May 9, 2014, Marketplace: “Since the launch of the Affordable Care Act last fall, some five million more Americans have enrolled in the nation’s healthcare program for low-income people. With only half the states expanding their Medicaid programs under the Affordable Care Act, researchers believe that number would double if all 50 states moved ahead, and several new reports suggest it may be cheaper for states to go ahead than previously estimated…”
  • Pa. plan to cover the uninsured back on track?, By Amy Worden and Don Sapatkin, May 8, 2014, Philadelphia Inquirer: “Signaling progress in its negotiations with the federal government, the Corbett administration said Thursday that it expected by January to launch its plan to provide health-care coverage for more than 500,000 low-income Pennsylvanians who lack insurance. Officials said they were so confident that the program would be up and running by Jan. 1 that they had decided to start soliciting contract proposals from private insurers. They hope to name at least two insurers for each of nine regions statewide by Aug. 1…”
  • Governor weighs Medicaid options, By Mike Dennison, May 9, 2014, Helena Independent Record: “A coalition of health care and business lobbies, state lawmakers and Gov. Steve Bullock’s office has been quietly discussing options to expand Medicaid in Montana, hoping to craft a compromise on the politically charged topic. ‘I think there are a lot of folks trying to come up with a solution,’ said Sen. Ed Buttrey, R-Great Falls, who’s part of the group. ‘The goals are cheaper cost, better (medical) service and a healthier population…”

ACA and Former Foster Youth

States enroll former foster youth in Medicaid, By Christine Vestal, April 30, 2014, Stateline: “One of the Affordable Care Act’s successes is a provision that allows young people up to 26 years old to remain on their parents’ health insurance. Under a similar, but less-known provision, young adults who have been recently released from foster care can also get Medicaid coverage, regardless of their incomes. An estimated 180,000 foster care alumni became eligible on Jan. 1. About 26,000 young adults 18 to 22 years old are released from foster care each year and left to fend for themselves without state protections. The age that a young adult in foster care loses benefits varies across the states. The new health care provision for former young people without parents in the picture grants them full Medicaid coverage until age 26 in the state where they lived when they left foster care…”