Insurance Coverage under the ACA

  • Immigrants, the poor and minorities gain sharply under Affordable Care Act, By Sabrina Tavernise and Robert Gebeloff, April 17, 2016, New York Times: “The first full year of the Affordable Care Act brought historic increases in coverage for low-wage workers and others who have long been left out of the health care system, a New York Times analysis has found. Immigrants of all backgrounds — including more than a million legal residents who are not citizens — had the sharpest rise in coverage rates.  Hispanics, a coveted group of voters this election year, accounted for nearly a third of the increase in adults with insurance. That was the single largest share of any racial or ethnic group, far greater than their 17 percent share of the population. Low-wage workers, who did not have enough clout in the labor market to demand insurance, saw sharp increases. Coverage rates jumped for cooks, dishwashers, waiters, as well as for hairdressers and cashiers. Minorities, who disproportionately worked in low-wage jobs, had large gains…”
  • Obamacare seems to be reducing people’s medical debt, By Margot Sanger-Katz, April 20, 2016, New York Times: “Even if you lack health insurance, you’ll probably be able to get treatment at a hospital in the event of a catastrophe — if you’re struck by a car, say. But having insurance can mean the difference between financial security and financial ruin. A new study is showing that, by giving health insurance to low-income people, Obamacare seems to have cut down on their debt substantially. It estimates that medical debt held by people newly covered by Medicaid since 2014 has been reduced by about $600 to $1,000 each year…”
  • Obamacare expanding coverage for the poor, study finds, By Karen Pallarito, April 20, 2016, Philadelphia Inquirer: “State Medicaid expansions under Obamacare have improved low-income Americans’ insurance coverage, increased their doctor visits and enhanced detection of chronic health conditions, which could lead to improvements in health, a new study suggests. The findings are important as policymakers continue to debate the value of expanding Medicaid, the publicly funded health insurance program for the poor, researchers said…”

Medicaid Expansion – Arkansas

Arkansas GOP governor uses veto to save Medicaid program, By Andrew Demillo (AP), April 21, 2016, Washington Post: “Gov. Asa Hutchinson on Thursday effectively saved Arkansas’ first-in-the-nation hybrid Medicaid expansion by voiding part of a budget bill that would have ended the subsidized insurance for more than 250,000 poor people. The Republican governor vetoed a provision in the Medicaid budget that ordered a Dec. 31 end to the program, which uses federal funds to purchase private insurance for the poor…”

ACA and Free Health Clinics

While more Americans are insured, free clinics still providing a safety net, By Kate Giammarise, March 28, 2016, Pittsburgh Post-Gazette: “The Affordable Care Act and expansion of Medicaid have brought health insurance to millions of previously uninsured Americans. But it’s still mostly business as usual at the Birmingham Free Clinic on Pittsburgh’s South Side, where about 90 percent of patients lack health insurance. The remaining 10 percent of patients at the clinic, located in a Salvation Army building off Carson Street, tend to bounce off and on Medicaid, clinical director Mary Herbert estimated…”

Medicaid Expansion – Wisconsin

Wisconsin uses Affordable Care Act but rejects funding for it, By Guy Boulton, February 29, 2016, Milwaukee Journal Sentinel: “Wisconsin’s decision last week to challenge a fee imposed by the Affordable Care Act set up a comparison not lost on advocates who support the law. The fee has cost the state about $23 million so far. In contrast, Gov. Scott Walker and the Legislature’s opposition to the law is projected to cost $678.6 million in state tax dollars through the 2017 fiscal year. That’s because Wisconsin is the only state in the country to use the Affordable Care Act to expand its Medicaid program while turning down the additional federal dollars available through the law to pay for it…”

State Medicaid Programs

  • Feds OK Medicaid privatization, with another delay, By Tony Leys and Jason Clayworth, February 23, 2016, Des Moines Register: “Gov. Terry Branstad gained federal approval Tuesday for his controversial plan to turn Medicaid over to private managers, but not until April 1.  Branstad originally planned to make the massive shift on Jan. 1. Federal administrators determined in December that Iowa was not ready to turn the 560,000 poor or disabled people who use the program over to three private management companies. They ordered the state to wait until at least March 1…”
  • New twists as Maine lawmakers again consider Medicaid expansion, By Joe Lawler, Feburary 23, 2016, Portland Press Herald: “Sen. Tom Saviello’s Medicaid expansion bill received a chilly reception from his fellow Republicans and the LePage administration Tuesday. The Wilton lawmaker received support from Democrats, however, and remained undeterred…”
  • Bill would block Medicaid expansion for another two years, By Laura Hancock, February 23, 2016, Casper Star-Tribune: “The state Legislature, which recently defeated Medicaid expansion, is debating a bill that would create a two-year state study of health coverage for low-income Wyomingites – a measure critics call a delay tactic for helping the poor and the hospitals who serve them.  But Sen. Charlie Scott, one of the sponsors of Senate File 86, said the measure is a compromise to Medicaid expansion, since the Legislature appears unwilling to extend the federal program to 20,000 low-income Wyoming adults under the Affordable Care Act.

Health Insurance Coverage

Gov’t report: Illinois among 8 states with significant drop in uninsured, Associated Press, February 9, 2016, Chicago Tribune: “Eight states saw a significant drop last year in the number of residents going without health insurance, according to a government report out Tuesday that has implications for the presidential campaign.  All but Florida had accepted a Medicaid expansion that is one of two major pathways to coverage under President Barack Obama’s health care law. The law’s other coverage route is subsidized private insurance, available in all 50 states…”

Medicaid Expansion – Indiana, Ohio

  • Hospitals boosted by Medicaid expansion, By Maureen Groppe, February 1, 2016, Indianapolis Star: “The biggest obstacle a Richmond, Ind., hospital has had in signing up low-income Hoosiers for Indiana’s expanded Medicaid program is convincing them it’s real.  ‘These are people who have never had this type of coverage before,’ said Chris Knight, the chief financial officer and vice president of Reid Health. ‘We have had very touching stories where people just break down and cry when they’re given this coverage.’  As Indiana enters its second year of expanded Medicaid coverage created by the Affordable Care Act, hospitals around the state report it has helped patients gain needed coverage.  But it’s helping hospitals, too.  The amount of unpaid bills Reid Health can’t collect from patients has dropped about 40 percent…”
  • Do Indiana’s poor Medicaid recipients really have skin in the game?, By Maureen Groppe and Shari Rudavsky, February 1, 2016, Indianapolis Star: “When Gov. Mike Pence sought federal permission to run an alternative Medicaid program in Indiana, one aspect was non-negotiable: Participants in the joint federal and state health care program for the poor would have to have ‘skin in the game.’  Even those with no monthly income would have to pay a minimum $1 a month toward their care, if they wanted to stay in the part of the Healthy Indiana Program (HIP 2.0) that offered better benefits and no co-payments…”
  • Medicaid cuts number of uninsured Ohio workers, By Randy Tucker, February 3, 2016, Dayton Daily News: “The number of Ohio workers who were employed but uninsured fell sharply in the first full year of expanded Medicaid coverage under the Affordable Care Act, according to a report released Wednesday by Families USA. On average, the rate of uninsured, mostly low-wage workers, fell by 25 percent in the 26 states that expanded Medicaid in 2014, the non-profit health care advocacy group found. That was about twice the rate of decline in non-expansion states, where the share of uninsured workers was cut by an average of 13 percent, according to the report…”

Health Care and Social Services Screenings

Feds to study health benefits of screening and linking to social services, By Jayne O’Donnell, February 3, 2016, USA Today: “The Obama administration is working to build evidence supporting increased federal and state spending on anti-violence, social service and other programs to improve life in poor neighborhoods and limit the growth in health care costs.  The move comes despite more limited reports done by outside groups and is designed to create a paper trail that makes the need for and efficacy of the programs for Medicare and Medicaid recipients indisputable by showing the cost savings…”

Medicaid Expansion

  • Has Obamacare’s Medicaid expansion reached a tipping point?, By Dan Mangan, January 26, 2016, CNBC: “They like their plans, and they’re likely to keep their plans.  Despite continued Republican efforts to repeal Obamacare, a key component of the law that has given millions of people health coverage — Medicaid expansion — could prove very difficult to undo, experts say. A growing number of states have signed up for that expansion of the government-run program for poor people, or are discussing doing so. Hospitals are becoming accustomed to the money that comes with expansion, and a majority of new enrollees are saying they are happy with their coverage…”
  • Utah lawmakers get creative with Medicaid expansion, By Wendy Leonard, January 24, 2016, Deseret News: “Despite years of discussing the issue without resolution, Utah lawmakers will again take on Medicaid expansion and various plans to implement it for the thousands of Utahns who remain uncovered by health insurance. And, while some lawmakers are taking approaches that have been tried before, others are trying new things — an indication of a potential desire to bring health care benefits closer to Utahns who can’t afford them…”

Medicaid Programs – Ohio, Louisiana

  • Should some Ohio Medicaid recipients have to pay premiums?, By Catherine Candisky, January 18, 2016, Columbus Dispatch: “Tens of thousands of low-income Ohioans could lose Medicaid coverage under a state plan to charge premiums and impose penalties on those who miss the payments, advocates for the poor warn…”
  • Louisiana’s Medicaid expansion enrollment could grow to 450,000, By Kevin Litten, January 22, 2016, New Orleans Times-Picayune: “The Department of Health and Hospitals is now forecasting that Louisiana’s Medicaid rolls could swell to nearly 450,000 people after initially projecting that as many as 300,000 uninsured could be covered under the federally funded program.  The department had originally based its projections based on U.S. Census data that counted about 306,000 people as uninsured. But there is also a population of about 130,000 people who are part of the Take Charge Plus program who are eligible to receive screening and treatment for sexually transmitted infections (STI) and family planning services for men and women even if they aren’t eligible for Medicaid coverage…”

Health Insurance Coverage – Kentucky

Kentucky’s newly insured worry about their health under next governor, By Amy Goldstein, November 9, 2015, Washington Post: “Amid the coal fields of eastern Kentucky, a small clinic that is part of the Big Sandy Health Care network furnishes daily proof of this state’s full embrace of the Affordable Care Act. It was here that Mindy Fleming handed a wad of tissues to Tiffany Coleman when she arrived, sleepless and frantic, with no health insurance and a daughter suffering a 103-degree fever and mysterious pain. ‘It will be all right,’ Fleming assured her, and it was. An hour later, Coleman had a WellCare card that paid for hospital tests, which found that 4-year-old Alexsis had an unusual bladder problem.  Such one-by-one life changes are the ground-level stakes ushered in by the election last week of businessman Matt Bevin as Kentucky’s next governor. The second Republican elected to the office in 48 years, he wrapped his campaign around a pledge to dismantle Kynect, the state’s response to the federal health-care law. If he follows through, the Bluegrass State would go from being perhaps the nation’s premier ACA success story to the first to undo the law’s results, razing a state insurance exchange and reversing its considerable expansion of Medicaid…”

Medicaid Coverage Gap – Missouri

Failure to expand Medicaid impacts thousands in Ozarks, By Jon Swedien, Springfield News-Leader: “Looking back over the past year, Terri McCulloch said she was like one of the living dead. The 52-year-old said a thyroid condition had rendered her sick and unable to work. And in the wake of a recent divorce, she was left scrambling for a new place to live and without the health insurance…”

Health Insurance and Low-Income Employees

Many low-income workers say ‘no’ to health insurance, By Stacy Cowley, October 19, 2015, New York Times: “When Billy Sewell began offering health insurance this year to 600 service workers at the Golden Corral restaurants that he owns, he wondered nervously how many would buy it. Adding hundreds of employees to his plan would cost him more than $1 million — a hit he wasn’t sure his low-margin business could afford. His actual costs, though, turned out to be far smaller than he had feared. So far, only two people have signed up. ‘We offered, and they didn’t take it,’ he said.  Evidence is growing that his experience is not unusual…”

State Medicaid Spending and Enrollment

  • Medicaid costs rise, report says, but not more than most states expected, By Abby Goodnaugh, October 15, 2015, New York Times: “Spending on Medicaid rose nearly 14 percent on average in the last fiscal year, a report has found, largely because of a tide of newly eligible enrollees in the 29 states that had expanded the program by then to cover millions more low-income adults. But for most of those states, the per-member, per-month cost of the new enrollees was not higher — in a few cases, in fact, it was lower — than expected, according to the report, released Thursday by the Kaiser Family Foundation. And almost all of the additional spending was covered by federal funds, which are paying the entire cost of expanding Medicaid through 2016 and at least 90 percent thereafter…”
  • Survey: Big growth in Medicaid enrollees in expansion states, By Christina A. Cassidy (AP), October 15, 2015, Washington Post: “States that opted to expand Medicaid under the Affordable Care Act saw enrollment increase on average by 18 percent during the first full year of expansion, according to a report released Thursday. That will soon have an effect on state budgets, with expansion states to pay a portion of costs to cover the new enrollees beginning in 2017. Currently, the federal government is covering the expanded population at 100 percent. States will eventually pay 10 percent of costs by 2020…”
  • Study: Nearly half of Iowa’s uninsured are eligible for Medicaid, By Ed Tibbetts, October 15, 2015, Quad-City Times: “A new study says nearly half of Iowa’s non-elderly uninsured are eligible for Medicaid, one of the highest rates in the nation. The Kaiser Family Foundation this week released a state-by-state analysis, which said 188,000 non-elderly are uninsured in Iowa, and 47 percent of them are eligible for Medicaid, the program that is run jointly by the federal government and the states to provide coverage for the low-income and disabled people…”

Medicaid Expansion – Arkansas, Pennsylvania

  • Arkansas governor wants to keep Medicaid expansion, but with changes, By Abby Goodnough, August 19, 2015, New York Times: “Gov. Asa Hutchinson of Arkansas on Wednesday told an advisory group weighing the future of the state’s alternative Medicaid expansion that he favored keeping it — but only if the federal government allowed changes that seemed intended to appeal to conservative legislators who continue to oppose the program. Mr. Hutchinson, a Republican who took office in January, created the advisory group to recommend whether to change or replace the state’s ‘private option’ version of Medicaid expansion. The program’s fate will ultimately be decided by the Republican-controlled legislature, which is likely to meet in a special session this year to vote on it…”
  • Pennsylvania’s Medicaid expansion simplifies enrollment, By Adam Smeltz, August 20, 2015, Pittsburgh Post-Gazette: “Low-income families who might have waited months for medical assistance last winter are enrolling within weeks under Pennsylvania’s Medicaid expansion, sailing through simplified applications that help them see doctors faster. ‘People are able to get the care and treatment they need much sooner. Folks are able to get preventive care much sooner,’ said Antoinette Kraus, state director at the nonprofit Pennsylvania Health Access Network, which urged policymakers to broaden traditional Medicaid. Still, critics remain cautious whether the expanded program could overburden the state budget…”

Medicaid and Dental Care

Dental care for Medicaid patients is expanding, but a study says that won’t reduce ER visits, By Robert Gebeloff, August 6, 2015, Washington Post: “A lack of dental care for low-income Americans has long put stress on hospital emergency rooms, a new study has found, bring hundreds of thousands of patients in to ERs for minor dental problems. The study, published this week in Health Affairs, found that in 2010, somewhere around 2 percent of all ER visits was dedicated to avoidable these patients, posing questions about how best to deliver dental care to poor people. Authors of the study argue, however, that an expansion of dental care under Medicaid alone won’t fix the problem. Patients relying on the federal program would still face limited access to dentists who are willing to take them…”

Medicaid and Preventive Care – Kentucky

Preventive care rises among Kentucky Medicaid patients, By Laura Ungar, August 5, 2015, Louisville Courier-Journal: “Kentuckians on Medicaid were far more likely to get cancer screenings, physicals and dental check-ups after the state expanded the government program for the poor and disabled through the Affordable Care Act, new state data shows…”

ACA and Safety Net Hospitals

Some public hospitals win, others lose with Obamacare, Reuters, July 23, 2015, NBC News: “A year and a half after the Affordable Care Act brought widespread reforms to the U.S. healthcare system, Chicago’s Cook County Health & Hospitals System has made its first profit in 180 years.  Seven hundred miles south, the fortunes of Atlanta’s primary public hospital, Grady Health System, haven’t improved, and it remains as dependent as ever on philanthropy and county funding to stay afloat.  The disparity between the two ‘safety net’ hospitals, both of which serve a disproportionate share of their communities’ poorest patients, illustrates a growing divide nationwide…”

Medicaid Expansion – Illinois

In Illinois, Medicaid expansion sign-ups double predictions, By Carla K. Johnson (AP), July 20, 2015, St. Louis Post-Dispatch: “Illinois is among a dozen states where the number of new enrollees surpassed projections for the expansion of Medicaid under President Barack Obama’s health law. While the surge in sign-ups lifts the number of insured people, it has also stoked worries about the future cost to taxpayers.  Illinois and Cook County eventually will have to bear 10 percent of the cost of expanding the safety-net insurance program for the poor. The federal government agreed to pay all costs for the expansion through 2016, but it will begin lowering its share in 2017.  More than twice as many Illinois residents have enrolled under the expansion than was projected by former Democratic Gov. Pat Quinn’s administration. It expected 298,000 people to sign up in 2015, but 623,000 newly eligible Illinoisans enrolled by the end of June. Sign-ups have outstripped forecasts in at least a dozen states, according to a new analysis by The Associated Press…”

States and Medicaid Expansion

On Medicaid expansion, a question of math and politics, By Christine Vestal, July 8, 2015, Stateline: “With its ruling in King v. Burwell last month, the U.S. Supreme Court likely settled the question of whether President Barack Obama’s signature Affordable Care Act will survive. Whether and when the health law will be fully implemented in all 50 states is a different question.  ‘With the King decision behind us, the drumbeats for Medicaid expansion are increasing,’ said Matt Salo, executive director of the National Association of Medicaid Directors. ‘There is movement in every state. They’ll get there. Maybe not today and maybe not this year, but they’ll get there soon.’  That’s the hope of health care industry groups and legions of consumer advocates. Major business organizations and local and county governments are also onboard. Following the high court’s decision, President Obama vowed to do all he can to persuade states to opt in before he leaves office in 18 months. But in the mostly Southern and Midwestern states that have rejected expansion, opposition shows little sign of abating…”