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…”

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…”

Medicaid Coverage

  • State’s low Medicaid payments pinch doctor practices in low-income areas, By Guy Boulton, July 19, 2014, Milwaukee Journal Sentinel: “Mohammad Qasim Khan, a primary care physician who oversees a private practice in a low-income neighborhood, well knows the discrepancy between what private insurance pays for his services and what the state’s Medicaid program pays. Khan, who works with another physician and three nurse practitioners at the Family Medical Clinic, 5434 W. Capitol Drive, estimates that the program’s payment rates are half — and in some cases, less than half — those of private insurance…”
  • U.S. hospitals get lift from surge in Medicaid sign-ups, By Susan Kelly, August 1, 2014, Philadelphia Inquirer: “U.S. hospitals are getting a stronger-than-expected benefit from a new influx of low-income patients whose bills are paid by the government’s Medicaid program, raising their profit forecasts as a result. The growing numbers of Medicaid patients helped hospital operator HCA Holdings Inc, the largest for-profit chain, post stronger earnings in the second quarter than initially forecast…”
  • CDC: Many kids with Medicaid use ER as doctor’s office, By Steven Reinberg, July 29, 2014, Lafayette Journal and Courier: “Children covered by Medicaid, the publicly funded insurance program for the poor, visit the emergency room for medical care far more often than uninsured or privately insured youngsters, a U.S. survey finds. And kids with Medicaid were more likely than those with private insurance to visit for a reason other than a serious medical problem, according to the 2012 survey conducted by the U.S. Centers for Disease Control and Prevention…”

State Medicaid Programs – Oregon, North Carolina

  • Medicaid enrollees strain Oregon, By Gosia Wozniacka (AP), July 23, 2014, ABC News: “Low-income Oregon residents were supposed to be big winners after the state expanded Medicaid under the federal health care overhaul and created a new system to improve the care they received. But an Associated Press review shows that an unexpected rush of enrollees has strained the capacity of the revamped network that was endorsed as a potential national model, locking out some patients, forcing others to wait months for medical appointments and prompting a spike in emergency room visits, which state officials had been actively seeking to avoid. The problems come amid nationwide growing pains associated with the unprecedented restructuring of the U.S. health care system, and they show the effects of a widespread physician shortage on a state that has embraced Medicaid expansion…”
  • Many low-income N.C. workers are locked out of Medicaid, By Karen Garloch, July 25, 2014, Charlotte News and Observer: “They’re construction workers, waitresses and cashiers. They care for our children and elderly parents, clean our offices and bathrooms. But they go without health insurance because their incomes aren’t high enough to qualify for federal subsidies and too high to qualify for North Carolina’s current Medicaid program for low-income and disabled citizens. More than half of the 689,000 uninsured adults North Carolinians who fall into this so-called “Medicaid gap” are employed in jobs that are critical to the state’s economy, according to a report released Thursday by the North Carolina Justice Center, the North Carolina Community Health Center Association and Families USA…”

Migrant Laborers

Migrant laborers slip through the tattered safety net in Texas, By Jay Root, June 30, 2014, Texas Tribune: “Along a street lined with warehouses on the east side of Houston, nine Mexican laborers working about 20 feet off the ground are tearing up a concrete roof with handmade pickaxes.They are chiseling it out, one mattress-size panel at a time, then shoving the debris onto the floor below. There’s a giant pile of rubble down there, a jumble of dirty insulation, tar-covered roof decking and fire-suppression water pipes ripped from the building’s interior. To call the work hazardous would be an understatement. The workers are standing on the very roof they are demolishing, and none of them is wearing so much as a hard hat, let alone fall protection equipment like harnesses and lanyards. Technically, federal authorities require that, but the chances of a surprise inspection — or any interference from a state government that brags about its light regulations. . .”

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. . .”