Medicaid Reforms Cause Varied Backlash

The concerns regarding Medicaid expansion are well founded and abundant. Every state seems to be approaching expansion efforts differently. As more data are collected and healthcare professionals go on record with their thoughts, strategies and approaches are being created. Here are some of the recent news stories regarding Medicaid expansion.

Before taking a look at some of the progress (or lack thereof) of individuals states’ Medicaid expansion efforts, it is important to look at the program as a whole and determine just who benefits from this expansion. The Kaiser Family Foundation did exactly that and released a comprehensive report outlining which demographics stand to gain from an expansion. The report expands on some of the following findings:

• Medicaid does not cover many low-income adults today.
• More than half of the nearly 50 million individuals who are currently uninsured have income below the new Medicaid eligibility thresholds, and 6 in 10 are adults without dependent children.
• Enrollment increases will vary significantly by state; disparities will be anywhere from less than 10% to at least 45%.
• The federal government will finance approximately 95% of the cost of Medicaid expansion from 2014-2019.

The state of New York is looking to provide the blueprint for how to cut Medicaid without harming the beneficiaries. How exactly? The states is asking the federal government to allow it to use the projected $10 billion in savings from healthcare reforms to “modernize hospitals and clinics serving the poor and to expand primary and preventive care.”

Not far from New York, things are looking bleak in Rhode Island. According to a new report, nearly one-third of doctors in the state will not be taking on new patients with Medicaid. Rhode Island’s acceptance rate (68.9%), however, is still higher than in two other states with especially low reimbursement rates: New Jersey (40.4%) and New York (61.6%). The report also references a study by National Center for Health Statistics economist Sandra Decker which found that “doctors were more likely to accept new Medicaid patients in states where the program’s reimbursement rates were closer to those offered by Medicare.”

Brenna E. Burch, Policy Analyst, Budget & Tax Center, North Carolina, reported this month that Medicaid expansion will help address long-standing racial healthcare disparities. “A greater share of people of color are uninsured than whites, and this lack of insurance is one reason for the continued disparities in access to health care in communities of color,” the report states. It goes on to say that “North Carolina must implement the Medicaid expansion responsibly and effectively in order to reduce racial health disparities and reap the benefits of improved health outcomes and resulting cost savings.”

In Texas, state lawmakers have been getting an earful from doctors in the southern part of the state. One of those outspoken leaders is the Texas Medical Association’s Carlos Cardenas, who recently brought to attention the sharp reduction in reimbursement rates for providers. “In one year — after all reductions are factored in – some providers reimbursement rates was cut more than 40%,” said Cardenas. “Without immediate action by the Texas Legislature and the Health and Human Services Commission, the continuation will erode our safety net of care. Providers have already begun exiting our South Texas community.”

According to the Wall Street Journal, Indiana, New Mexico and Wisconsin “are among the states asking the federal government to let them omit from the Medicaid expansion residents whose incomes put them just above the poverty level,” and that "the states hope to take advantage of provisions in the Affordable Care Act that offer a federal subsidy to help these residents buy private insurance, starting in 2014.”

As you can see, there are a plethora of outlooks on Medicaid expansion and they vary somewhat drastically depending on what part of the country you’re in. At any given moment, Twitter users can check the pulse of Medicaid expansion discussions on Twitter by searching #Medicaid. Doing so will provide a real-time check of Medicaid expansion progress as well as links to plenty of articles that feature the strategies of individual states.

Around the Web

States' Use of Managed Care [US Government Accountability Office]

States Continue to Weigh Pros and Cons of Medicaid Expansion [AJMC]

Who Benefits from the ACA Medicaid Expansion? [Kaiser Family Foundation]

New York’s Medicaid Reforms [New York Times]

Study: 1 in 3 RI doctors aren’t accepting new Medicaid patients [WPRI]

Managed Care Troubles South Texas Docs [KUT]

BTC BRIEF: Health Care Disparities and the Medicaid Expansion [North Carolina Justice Center]

States Seek a Middle Ground on Medicaid [Wall Street Journal]