Health Care Spending – Massachusetts

Low-income communities see fewer health care dollars, AG report finds, By Priyanka Dayal McCluskey, October 13, 2016, Boston Globe: “Massachusetts’ health insurance market has an income inequality problem, according to a report from Attorney General Maura Healey’s office, whose findings mirror national studies.  The analysis found that more health care dollars are spent on higher-income communities than on lower-income communities — even though the latter tend to have greater medical needs. Healey’s office called this a ‘distressing’ trend that has persisted for years…”

States and Medicaid Expansion

  • How expanding Medicaid can lower insurance premiums for all, By Margot Sanger-Katz, August 25, 2016, New York Times: “The Obama administration for years has been pleading with states to expand their Medicaid programs and offer health coverage to low-income people. Now it has a further argument in its favor: Expansion of Medicaid could lower insurance prices for everyone else.  A new study published by in-house researchers at the Department of Health and Human Services compared places that have expanded their Medicaid programs as part of Obamacare with neighboring places that have not. They found that, in 2015, insurance in the marketplace for middle-income people cost less in the places that had expanded Medicaid…”
  • Controversial parts of Medicaid plan remain, By Tom Loftus and Deborah Yetter, August 25, 2016, Louisville Courier-Journal: “Gov. Matt Bevin’s administration unveiled its long-awaited plan to reshape the state’s Medicaid program Wednesday, and while it restores some benefits Bevin proposed be cut two months ago, it retains the most controversial components of the governor’s approach to overhauling the federal-state health plan for low-income and disabled Kentuckians.  Taking aim at the Medicaid expansion launched by his predecessor, Democrat Steve Beshear, under the federal Affordable Care Act, Bevin, a Republican, has said he wants to create a different program that includes more cost-sharing by consumers, encourages more personal responsibility, and brings the state’s soaring costs of Medicaid under control…”

Medicaid and Home Health Visits

House calls might save Medicaid money for states, By Michael Ollove, August 25, 2016, Stateline: “Doctors who make house calls may seem like something from America’s Norman Rockwell past. But they never disappeared entirely, and there is new evidence that home visits can play an important role in providing health care to the aged and chronically ill — while saving taxpayers millions.  The federal Centers for Medicaid and Medicare Services (CMS) said this month that a demonstration project has shown that delivering comprehensive primary care services at home helped to keep Medicare recipients with multiple chronic illnesses or disabilities out of hospitals, emergency rooms and nursing homes…”

Child Food Allergies in Low-Income Households

Why having a food allergy costs more for the poorest kids, By Deborah Netburn, April 27, 2016, Los Angeles Times: “What is the financial toll of having a kid with a food allergy? The answer may depend on how much money you have. A new study published this week in Pediatrics found that food-allergic children from households that earn less than $50,000 a year incur 2.5 times the cost of emergency room visits and hospital stays compared with their peers from families that are in a higher-income bracket.  At the same time, families that make more than $100,000 a year report spending more of their own money on visits to allergy specialists for their kids, as well as medicines paid for out of pocket, compared with families from lower-income groups…”

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…”

Rural Hospitals

To survive, rural hospitals join forces, By Michael Ollove, August 17, 2015, Stateline: “Ask Sam Lindsey about the importance of Northern Cochise Community Hospital and he’ll give you a wry grin. You might as well be asking the 77-year-old city councilman to choose between playing pickup basketball—as he still does most Fridays—and being planted six feet under the Arizona dust. Lindsey believes he’s above ground, and still playing point guard down at the Mormon church, because of Northern Cochise. Last Christmas, he suffered a severe stroke in his home. He survived, he said, because his wife, Zenita, got him to the hospital within minutes. If it hadn’t been there, she would have had to drive him 85 miles to Tucson Medical Center. There are approximately 2,300 rural hospitals in the U.S., most of them concentrated in the Midwest and the South. For a variety of reasons, many of them are struggling to survive…”

State Medicaid Program – Ohio

Medicaid costs nearly $2 billion below estimates in Ohio, By Catherine Candisky, August 12, 2015, Columbus Dispatch: “Despite higher than expected enrollment of Ohioans newly eligible for Medicaid, overall costs of the tax-funded health insurance program last year were nearly $2 billion below original estimates. According to a report released today by Gov. John Kasich’s administration, total Medicaid spending was $23.5 billion for the fiscal year ending June 30, about 7.6 percent less than projected…”

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…”

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…”

State Medicaid Program – Arizona

Arizona hospitals, doctors avoid 5 percent Medicaid pay cut, By Ken Alltucker, June 10, 2015, Arizona Republic: “Arizona hospitals, doctors and other health providers will get a reprieve after the state’s Medicaid program announced it will cancel a planned 5 percent payment cut because of lower-than-expected use among enrollees and a prescription-drug rebate.  The combination will provide enough financial relief to keep Medicaid’s existing payment rates, according to a spokesman for Gov. Doug Ducey…”

States and Medicaid Expansion

States find savings through Medicaid expansion, By Michael Ollove, April 29, 2015, Stateline: “Medicaid expansion has given a budget boost to participating states, mostly by allowing them to use federal money instead of state dollars to care for pregnant women, inmates, and people with mental illness, disabilities, HIV/AIDS, and breast and cervical cancer, according to two new reports.  States that levy assessments and fees on health care providers, which have collected higher revenues as a result of expansion, have reaped extra benefits…”

State Medicaid Costs

  • Alabama Medicaid burden rising more slowly than most states, study shows, By Brendan Kirby, April 23, 2015, Press-Register: “During Alabama’s latest budget crisis, lawmakers often have pointed to out-of-control Medicaid costs as one of the leading culprits. A report released Wednesday by the Pew Charitable Trusts, however, suggests that costs relative to state revenues have been much more manageable in Alabama than most other states over the past decade…”
  • State Medicaid costs grow, By Phil Kabler, April 22, 2015, Charleston Gazette: “Medicaid costs accounted for 11.4 percent of the state’s general revenue budget in 2013, up from 8 percent in 2000, a study released Wednesday by the Pew Charitable Trusts shows. Still, that was below the national average of 16.9 percent in 2013, an average that grew from 12.2 percent in 2000…”

Medicaid Expansion and Safety-Net Hospitals

Economy boosts safety-net hospitals in states not expanding Medicaid, By Phil Galewitz, March 1, 2015, Washington Post: “Hospitals that treat many poor and uninsured patients were expected to face tough financial times in states that did not expand Medicaid under the Affordable Care Act.  That’s because they would get less Medicare and Medicaid funding under the health-care law, while still having to provide high levels of charity care.  But in some of the largest states that did not expand Medicaid, many ‘safety net’ hospitals fared pretty well last year — better than in 2013 in many cases, according to their financial documents…”

Health Insurance Coverage

  • Health law drives down U.S. rate of uninsured adults, survey finds, By Noam N. Levey, February 24, 2015, Los Angeles Times: “America’s uninsured rate plummeted last year, with the improvement driven by states that have fully implemented the Affordable Care Act, a new nationwide Gallup survey indicates.  Led by Arkansas and Kentucky, which both had double-digit declines, seven states saw the percentage of adults without insurance fall by more than 5 percentage points between 2013 and 2014…”
  • Survey: Uninsured rate hit new low in 2014, By Ricardo Alonso-Zaldivar (AP), February 24, 2015, ABC News: “Even as it faces another Supreme Court challenge, President Barack Obama’s health care law has steadily reduced the number of uninsured Americans, according to an extensive survey released Tuesday.  The Gallup-Healthways Well-Being Index found that the share of adults without health insurance dropped to its lowest level in seven years in 2014 as Obama’s overhaul took full effect.  The trend appears likely to continue, since 55 percent of those who remained uninsured told the pollster they plan to get coverage rather than face rising tax penalties…”
  • The stark North-South divide in health insurance, By Aimee Picchi, February 24, 2015, CBS News: “When it comes to health care coverage, America is becoming a land of geographically based haves and have-nots.  States with the lowest uninsured rates are clustered in the Northeast and upper Midwest, while those with the highest rates of uninsured Americans are mostly inSouthern states such as Georgia and Louisiana, according to a new study from Gallup. One reason is that many Southern states opted out of expanding Medicaid coverage under Obamacare…”
  • Medicaid enrollment surges across the U.S., By Kimberly Leonard, February 24, 2015, US News and World Report: “Much of the focus of the health care law in recent months has centered on whether the government could get millions of people to sign up for private health insurance through federal or state exchanges. But the Affordable Care Act also expands health insurance for Americans with the lowest incomes – by giving them greater access to public coverage through Medicaid and the Children’s Health Insurance Program…”
  • Congress is told ruling against health law would impact poor, By Robert Pear, February 24, 2015, New York Times: “The Obama administration told Congress on Tuesday that it had no plans to help low- and moderate-income people if theSupreme Court ruled against the administration and cut off health insurance subsidies for millions of Americans.  Sylvia Mathews Burwell, the secretary of health and human services, said a court decision against the administration would do “massive damage” that could not be undone by executive action.

Immigrants and Health Insurance Coverage – California

Calif. has novel view of health care for undocumented immigrants, By Anna Gorman, January 17, 2015, USA Today: “Angel Torres hasn’t been to the doctor since coming to the United States illegally more than two decades ago. But now, his vision is getting blurry and he frequently feels tired. Torres, 51, worries he might have diabetes like his brothers. ‘Time is passing,’ he said in Spanish. ‘I need to get checked out.’ Torres is in luck. He lives in California, which has a dramatically different approach to health care for undocumented immigrants than most other states…”

State Medicaid Programs – New Jersey, Ohio

  • N. J. Medicaid fiasco: Thousands stranded without coverage, no fix in sight, By Kathleen O’ Brien, December 23, 2014, Star-Ledger: “The doctor was perfectly clear after examining Aurora Blackwell’s son this fall: The boy needed to get to an emergency room for his worsening digestive problems. Instead, Blackwell took the 4-year-old home and treated him herself — first with prune juice, then suppositories. Why would the devoted young mother of two ignore her pediatrician’s advice? Because the Burlington County woman knew that despite 10 months of phone calls, emails and letters, her family still lacked health insurance. ‘I feel helpless,’ she’d written two months earlier in a plea to Gov. Chris Christie. ‘How much longer do we have to wait?’ The meltdown of the federal government’s website tied to the Affordable Care Act has been well documented. But in New Jersey, something far worse was happening as the state expanded Medicaid access under Obamacare, an NJ Advance Media investigation has found…”
  • Medicaid extension again on Kasich agenda, By Catherine Candisky, December 23, 2014, Columbus Dispatch: “Nearly one year after Ohio expanded Medicaid coverage for poor adults, Gov. John Kasich again faces uncertainty as he seeks approval from the Republican-led legislature to extend new eligibility guidelines for two more years. The governor and other supporters say lives are at stake. As of October, more than 430,000 poor Ohioans had gained health coverage under the expansion paid through federal funding available through the Affordable Care Act…”

Medicaid Programs – Oregon, California

  • Oregon to use Kentucky Medicaid system, By Saerom Yoo, December 9, 2014, Statesman Journal: “The Oregon Health Authority will import Kentucky’s online Medicaid enrollment system, marking the second phase of the state’s transition in the face of last year’s Cover Oregon technology mess. OHA Medicaid Director Judy Mohr Peterson made the announcement to legislators in the Capitol on Monday, saying the Kentucky exchange system has been successful, that it has the kind of functionality Oregon needs and that the state has a similar Medicaid population to Oregon…”
  • California managed-care pilot program meets resistance, By Anna Gorman, December 6, 2014, Washington Post: “California’s initial efforts to move almost 500,000 low-income seniors and disabled people automatically into managed care has been rife with problems in its first six months, leading to widespread confusion, frustration and resistance. Many beneficiaries have received stacks of paperwork they don’t understand. Some have been mistakenly shifted to the new insurance coverage or are unaware they were enrolled. And a third of those targeted for enrollment through Nov. 1 opted out, indicating they will stick with their traditional coverage. Prompted by the Affordable Care Act, the federal government is trying to streamline services and cut costs for the 9 million Americans who are in both Medicare and Medicaid. A dozen states have received grants to launch pilot projects, and five are enrolling participants — Virginia, Ohio, Massachusetts, Illinois and California…”

Medicaid Program – Arizona

In Arizona, swings in Medicaid access show program’s impact, By Noam N. Levey, November 30 2014, Los Angeles Times: “Bad timing turned Karen Slone’s medical problem into a crisis. Slone, 53, a former administrative assistant with diabetes, followed doctors’ advice for years, getting regular checkups. Then, last year, she lost her job and her insurance, and stopped going to the doctor. When she spotted a sore on her foot, a common complication of diabetes, Slone tried Neosporin and Band-Aids. By the time she went to an emergency room weeks later, she had a raging infection. Surgeons had to remove bones in two toes. ‘It was awful,’ Slone recalled. ‘If I’d have been covered, I would have gone to the doctor sooner.’ For low-income adults like Slone, Arizona was once a trailblazer in healthcare, providing broad access to Medicaid, the government health plan for the poor…”

Health Insurance Coverage

  • For those who make too much — and too little — for health insurance, the options are limited, By Jordan Shapiro, October 9, 2014, St. Louis Post-Dispatch: “Beverly Jones, a 51-year-old St. Louisan with custody of her three grandchildren, is supposed to get her blood tested every few months to make sure the medicine she takes daily isn’t harming her kidneys. But she can only afford to make the trip to the doctor two times a year because she lacks health insurance. ‘It’s hard for me to accept that I put in so much work and so much time and now that I get sick there is no one that can help me,’ she said. ‘That doesn’t seem fair to me.’ Jones isn’t alone. She is one of nearly 300,000 Missourians who would qualify for government-funded health insurance if they lived across the Mississippi River in Illinois or in 26 other states that have decided to expand their Medicaid programs under the Affordable Care Act. But because Missouri hasn’t agreed to expand its program, Jones said she is forced to go without her blood tests and some of her prescriptions…”
  • Medicaid, often criticized, is quite popular with its customers, By Margot Sanger-Katz, October 9, 2014, New York Times: “Low-income people in three Southern states were recently asked whether they preferred Medicaid or private insurance. Guess which one they picked? A study published in the journal Health Affairs found that poor residents of Arkansas, Kentucky and Texas, when asked to compare Medicaid with private coverage, said that Medicaid offered better ‘quality of health care’ and made them better able to ‘afford the health care’ they needed. Medicaid, the federal-state program for poor and disabled Americans, is a frequent political target, often described as substandard because of its restricted list of doctors and the red tape — sometimes even worse than no insurance at all. But repeated surveys show that the program is quite popular among the people who use it…”
  • A quarter of Latinos are uninsured, By Teresa Wiltz, October 10, 2014, Stateline: “In the ‘sala de espera,’ or waiting room, at La Clinica del Pueblo, a community health center in Washington, D.C., signs in Spanish encourage patients to ‘Empower yourself!’ and sign up for insurance coverage through the Affordable Care Act. Adults slump in chairs, scribbling on application forms, texting friends, waiting. In a tiny office a few feet away, William Joachin, the center’s patient access manager, faces down the frustrations of trying to navigate the federal health care program for the thousands of mostly Central American immigrants who flood the clinic each year. He’s not alone. A year after open enrollment for the ACA began, one in four Latinos living in the U.S. does not have health insurance, according to new census data, more than any other ethnic population in the country—and most states have few backups in place to help those in the coverage gap…”

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…”