Showing posts with label
Medicaid as a major component of ACA.
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Showing posts with label
Medicaid as a major component of ACA.
Show all posts
‘The implementation of major legislation such as the Affordable Care Act (ACA) often results in fiscal outcomes that differ significantly from prior projections. Whenever this happens it leads to many questions, much confusion, and several claims and counter-claims. Rarely is it immediately clear whether the law is working differently than envisioned, or whether the unexpected outcomes are due to inevitable projection errors having nothing to do with the law.
On rare occasion, however, a prior projection proves so far off that its significance must be noted. Two weeks ago my colleague Brian Blase uncovered such a development with respect to the ACA’s Medicaid expansion. Recall that the ACA considerably expanded Medicaid eligibility – an expansion made optional for the states in a later Supreme Court ruling. It turns out that the 2015 per-capita cost of this Medicaid expansion is a whopping 49% higher than projections made just one year before.
This disclosure can be found on page 27 of the 2015 Actuarial Report for Medicaid, released this July. Here is how the report described the issue:
“While the newly eligible adult per enrollee costs in 2014 were slightly lower than estimated in last year’s report ($5,488 compared to $5,517, or about 1 percent lower), the estimated per enrollee costs for 2015 in this year’s report are substantially greater ($6,366 compared to $4,281, or about 49 percent higher).”’ - The Soaring Costs of the ACA’s Medicaid Expansion, economics21.org, 08/01/2016
Link to the entire essay appears below:
http://www.economics21.org/html/soaring-costs-aca%E2%80%99s-medicaid-expansion-1989.html
‘The implementation of major legislation such as the Affordable Care Act (ACA) often results in fiscal outcomes that differ significantly from prior projections. Whenever this happens it leads to many questions, much confusion, and several claims and counter-claims. Rarely is it immediately clear whether the law is working differently than envisioned, or whether the unexpected outcomes are due to inevitable projection errors having nothing to do with the law.
On rare occasion, however, a prior projection proves so far off that its significance must be noted. Two weeks ago my colleague Brian Blase uncovered such a development with respect to the ACA’s Medicaid expansion. Recall that the ACA considerably expanded Medicaid eligibility – an expansion made optional for the states in a later Supreme Court ruling. It turns out that the 2015 per-capita cost of this Medicaid expansion is a whopping 49% higher than projections made just one year before.
This disclosure can be found on page 27 of the 2015 Actuarial Report for Medicaid, released this July. Here is how the report described the issue:
“While the newly eligible adult per enrollee costs in 2014 were slightly lower than estimated in last year’s report ($5,488 compared to $5,517, or about 1 percent lower), the estimated per enrollee costs for 2015 in this year’s report are substantially greater ($6,366 compared to $4,281, or about 49 percent higher).”’ - The Soaring Costs of the ACA’s Medicaid Expansion, economics21.org, 08/01/2016
Link to the entire essay appears below:
http://www.economics21.org/html/soaring-costs-aca%E2%80%99s-medicaid-expansion-1989.html
“Medicaid enrollment has surged 19% nationally since ObamaCare’s expansion—50% in New Mexico, 65% in Oregon, 81% in Kentucky—and spending is exploding. So taxpayers ought to be grateful that the Supreme Court declined 5-4 on Tuesday to convert this entitlement—and all the others—into a private right.
Medicaid, the joint state-federal program originally meant for the poor and disabled, sets price controls for all health-care services. And in the law that created the program, Congress instructed the states to “assure that payments are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers” equal to those available to the general population. In Armstrong v. Exceptional Child Center, a group of in-home care companies sued Idaho for setting reimbursement rates too low, thus purportedly violating this amorphous standard.”
“Medicaid’s fire-sale reimbursement rates often result in inferior care and distort markets, but they might be more generous if the program was limited to its original purpose of helping the poor. Also recall that Medicaid is an entitlement for providers as much as beneficiaries, and they don’t have to participate.
Armstrong was a backdoor bid to reflate the judicial rate-setting that providers have long sought but the Court rebuked in 2002 in Gonzaga v. Doe, holding that spending programs do not create judicially enforceable rights like those in the Constitution. So mark this one down as a victory for judicial and fiscal restraint.” - Close Encounters of the Medicaid Kind, WSJ, 04/01/2015
Link to the article appears below:
http://www.wsj.com/articles/close-encounters-of-the-medicaid-kind-1427846690?KEYWORDS=medicaid
"In addition to financial barriers to care, there are non-financial ones – mainly caused by the narrow networks that have emerged in the insurance company race to the bottom. These networks often exclude the best doctors and the best hospitals. A study by Avalere found that there were no cardiologists in the networks of plans offered in Los Angeles. There were no diagnostic radiologists in the networks of plans offered in Chicago. In seven of the nine urban areas, fewer than half of specialists sampled belonged to provider networks in Obamacare exchanges. Patients can be forced to pay 100 percent of the cost of out-of-network services.
Here is another problem: millions of Americans are being forced to switch to the wrong kind of insurance. For example, many employees of fast food restaurants have mini med insurance, which covers the first few thousand dollars of care. These employees tend to be young and healthy and mini med plans pay for primary care – which is about the only care they are likely to need. The Obama administration considers that kind of insurance “under insurance,” however, and the new law insists that people have coverage for catastrophic care, with no annual or life time limits. Yet this kind of “comprehensive coverage” often has very high deductibles – forcing the young and the healthy to pay for primary care out of pocket.
About half the newly insured will get insurance through Medicaid, where there is little or no cost sharing. But here again, there are serious non-financial barriers to care. According to a study by the inspector general of the Department of Health and Human Services about half the doctors who are listed by insurers as serving Medicaid patients are not available to treat them. Those who are available often require long waits:
“For example,” the report said, “a number of obstetricians had wait times of more than one month, and one had wait times of more than two months for an enrollee who was eight weeks pregnant. Such lengthy wait times could result in a pregnant enrollee receiving no prenatal care in the first trimester of pregnancy.”
“Primary care providers, such as family doctors, internists and gynecologists, were less likely to offer appointments than specialists, the report said. But specialists tended to have longer wait times, with a median wait of 20 days, compared with 10 days for a primary care provider.”
These problems will almost certainly get worse in January when an end comes to a special Obamacare subsidy that has been enhancing the fees of Medicaid doctors for the last two years. According to the Washington Post:
“A study … from the nonpartisan Urban Institute estimated fee reductions will average about 40 percent nationwide. But they could reach 50 percent or more for primary care doctors in California, New York, New Jersey, and Illinois — big states that have all expanded Medicaid under the health law.
A system-wide problem will add to these woes: we are about to experience a severe rationing problem. If the economic studies are correct, the newly insured will try to consume twice as much health care once they have insurance and there may eventually be 25 million of them. Along the way almost everyone else is being forced to have more generous insurance than they previously had and with these new benefits they are likely to seek more care. The result: we are in the process of greatly expanding the demand for care while doing virtually nothing about supply.’ - Is Obamacare Working? John Goodman, Forbes, 12/15/2014
Link to the entire article appears below:
http://www.forbes.com/sites/johngoodman/2014/12/15/is-obamacare-working/
‘WASHINGTON (Reuters) - One part of the Affordable Care Act is going according to plan, with U.S. states receiving and spending more money on the Medicaid health insurance program, a report released by the National Association of State Budget Officers on Thursday showed.’
‘"The large increase in federal funds to states in fiscal 2014 was almost solely due to additional Medicaid dollars, mainly resulting from the expansion of Medicaid in a majority of states under the Affordable Care Act," the association found. "While federal Medicaid funds to states increased $41.8 billion in fiscal 2014, all other federal funds to states are estimated to have declined $3.4 billion."‘
‘Medicaid spending rose the most of all states' budget areas, increasing 11.3 percent in fiscal 2014, but the federal government shouldered most of the burden. Federal funding for Medicaid increased 17.8 percent, and state dollars directed to the program only grew 2.7 percent, according to NASBO.’ - U.S. states get more, spend more on Medicaid under Obamacare: report, 11/20/2014, yahoo news.com
Link to the entire article appears below:
http://news.yahoo.com/u-states-more-spend-more-medicaid-under-obamacare-051651014--business.html
