Unless the program receives enough money from premiums to offset the administrative costs of collecting that money, “small premiums seem difficult to justify as anything other than a measure to discourage enrollment,” the authors write.
We’re not surprised to see there’s proof that the woodwork effect is in effect in states that chose not to expand Medicaid.
According to a new Avalere Health analysis, 17 of the 26 states that did not expand Medicaid in the first three months of 2014 still reported growth in Medicaid enrollment, ranging from 0.1 percent in Texas to 10.1 percent in Montana.
Or as Adrianna McIntyre writes in Vox, “Medicaid will grow whether states want it to or not.”
It takes me back to that surreal moment in 2012 when the State of Florida argued before the U.S. Supreme Court that it would be harmed by the ACA (specifically the individual mandate) because additional Medicaid eligibles would probably sign up.
That led to Justice Kagan’s classic response:
That does seem odd, to suggest that the State is being injured because people who could show up tomorrow with or without this law will–will show up in greater numbers. I mean, presumably the State wants to cover people whom it has declared eligible for this benefit.
Poignant comments from Oregon Medicaid lottery winner Mary Carson, 55, commenting on the recent study suggesting the program had “no statistically significant effect on measured blood pressure, cholesterol or…diabetic blood sugar control.”
From a blog post:
I lost 40 pounds the first year, regained 15, and lost another 10 the next year. Now my doctor wants me to try for another 10 pound loss. I have gone from 3 blood pressure medicines to 1, and that’s at a half dose. This whole time my blood pressure stayed the same, but dropping 2 pills and keeping the same score is a health upgrade. My blood sugar is still pre-diabetic, but diabetes is a progressive disease. If you keep your blood sugar at the same level for 2 years, you are making progress with managing diabetes. The study would have found me to make no progress, but my doctor thinks I have improved.
The last point is that diabetes and cholesterol are both food-based diseases. The Oregon Medicaid project enrolled very poor adults….So none of us have access to unlimited fresh fruit and low fat meat. We still eat nothing but carbs for most meals….
What I would like to see is a study that shows the changes in these measurements over a 2 year period for people who have insurance. People with insurance for the last 20 years are not always improving their health, either.
And from the Washington Post
Some people have completely lost track of what health insurance is supposed to be. We’re talking about somebody being able to get their broken arm fixed if they fall out of a tree….
One of the things you get in Oregon is you get your teeth cleaned and X-rayed once a year. I hadn’t been to the dentist in six or eight years except to have a tooth pulled. So it was really nice to have my teeth cleaned and find out I don’t have cavities and don’t need my teeth pulled. My father died of melanoma and there’s a lot of melanoma in my family—one of my sons had skin cancer when was he was 15—and so that’s a worry. Being able to go to the doctor and have my moles checked was a big weight off my mind. I’m a lot surer I’m going to be able to make it to 70 without being crippled or in a wheelchair and not being able to take care of myself.
And there’s something about just feeling like you’re part of regular life. There’s a lot of emphasis on how everyone should be healthy and everyone should live longer, and you don’t want to be a burden on society. If you don’t have medical insurance, you’re kind of not part of that. It’s hard to explain, but there’s an element of participating in society that being able to go to the doctor gives you. Everybody always asks everyone how you’re doing, and to be able say “My doctor says I’m doing really well,” that’s nice, instead of being in a group of people and saying, “Well, I don’t really go to doctors.”
Not so likely, says Justin Lake of J.P. Morgan. That’s because Arkansas expects covering the poor through exchanges will cost only 13% to 14% more than if it expanded its Medicaid program. The differential isn’t that much, Lake suggests, because Arkansas pays Medicaid providers rates that are just 25% less than commercial insurance. In other states the gap is typically wider, Lake says:
Even if this relatively low cost premium is true for Arkansas and accepted by HHS as meeting the definition of cost effective, the gap between Medicaid and commercial rates is typically much wider (we estimate a differential of 85%-95% for the hospital companies in our coverage universe), possibly making Arkansas less likely to set a precedent for other states.
GAO says in a new report that Medicare plans were overpaid $3.2 billion to $5.1 billion in the three years from 2010 to 2012. Scott Fidel of Deustche Bank says that the report comes at a particularly bad time given recently proposed cuts to 2014 Medicare Advantage rates. Health plans are lobbying against the cuts, but Fidel notes that many are required by ObamaCare and the GAO report only reinforces the need for them. The overpayments relate to risk scores assigned to Medicare plan members, which GAO says were inappropriately high. Additional pressure on risk scores could push final rates (scheduled for release April 1) down even more, further impacting Medicare plans margins in 2014 and 2015, Fidel says.
From the Congressional Budget Office: Government spending on healthcare is projected to go from nearly 5% of GDP in 2013 to 6.2% in 2023.