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SPN Medicaid Exchange - Issue 130

Published on Thursday, February 02, 2012

SPN Medicaid Exchange - Issue 130

What's New in Medicaid
And Other Health Care Issues

Private Insurance Has Better Outcomes than Medicaid

The recent claim that Medicaid is better and cheaper coverage than private insurance is not all it's cracked up to be, says Linda Gorman at John Goodman's Health Policy Blog. Gorman explains that this is true only if one believes that the total cost of Medicaid is reflected by the payments it makes to providers.

ObamaCare Medicaid Expansions Will Be Costly to States

States are finally realizing that the ObamaCare Medicaid expansion makes it difficult or impossible to control their Medicaid expenditures. They are responding to the challenge in a variety of ways, some of which will likely put people's lives at risk, points out Linda Gorman at John Goodman's Health Policy Blog.

Nearly a Quarter of Americans Received Medicaid in 2010

According to Census data, in 2010 48.6 percent of the population lived in a household receiving some type of government benefits. The Wall Street Journal reports that the biggest increases came from an uptick in those turning to food stamps and Medicaid, with 26 percent receiving Medicaid in 2010.

Coercive Medicaid Expansion to Burden States More in Future

States are fiscally burdened by Medicaid and the problem may only become worse when ObamaCare's Medicaid expansion arrives in 2014. The Heritage Foundation reveals that states are concerned that the expansion infringes on state sovereignty by coercing state governments and commandeering state resources. The expansion makes it impossible for states to actually opt out of Medicaid, according to The Hill.

Could ObamaCare's Medicaid Expansion be Unconstitutional?

While most of the public debate on the constitutionality of the health reform law has centered on the "individual mandate," the Supreme Court has also agreed to consider another, far less discussed issue: whether the law's expansion of Medicaid eligibility might be an unconstitutional federal infringement on state legislative authority, says Forbes contributor Robert Book.

Medicaid and Medicare

A new report from actuarial consulting firm Milliman, Inc., shows a provision of the health reform law intended to tax health insurance companies to help fund coverage expansions, will be paid entirely by state Medicaid programs for the portion assessed to Medicaid managed care organizations, reports Yahoo! News. The report concludes the cost to states is greater than previously thought, with one-sixth of the total fee being paid by Medicaid health plans

A Medicaid Mess

Medicaid already is unable to pay for the best possible care for the neediest people. It's impossible to see how the program can also pay for those who could have provided for themselves, or why it should, writes Thomas G. Donlan on the Barron's editorial page.

States Ease Barriers to Medicaid, CHIP Enrollment. Enrollment Steady in 2011.

According to Kaiser Health News, eight states expanded eligibility rules so more children would qualify for Medicaid or the Children's Health Insurance Program, despite lingering effects from the recession and burdened state budgets. Additionally, MedPageToday reports, 41 states made it easier for low-income people to gain access to coverage by simplifying enrollment procedures, lowering the bar for eligibility, or bearing a greater brunt of the cost of coverage so beneficiaries had to pay less of their own money.

Prescription Drug Rule to Shift Costs

A rule that shifts more of the cost to drugmakers and pharmacies will bring Medicaid spending on prescription drugs down by about $17.7 billion. The rule means that drugmakers, led by Pfizer Inc., will pay an increased rebate pay each time their products are dispensed to Medicaid patients, according to Bloomberg.

National Conference of Legislators Pushes Back Against Medicaid Spending Levels

The National Conference of Legislators is urging the president and congressional leaders to examine discretionary spending, entitlement reform and revenue-related options as avenues for deficit reduction. According to Reuters, the Conference is concerned that states will struggle if a disproportionate and excessive burden is transferred to them and said the federal government should not force them to maintain high spending levels for Medicaid.

ObamaCare's Effect on Women Covered by Medicaid

A new issue brief from the Kaiser Family Foundation discusses the role of Medicaid for women and examines how changes under ObamaCare will affect the program and women covered by Medicaid. The brief explores Medicaid's role for women across their lifespans including reproductive health services, care for chronic conditions and disabilities, and long-term care services.

Federal Law Forces States to Streamline Medicaid

A stipulation in ObamaCare has forced states to be more efficient in managing the program to save money, according to the Kaiser Family Foundation as reported by Bloomberg. The stipulation bans U.S. states from dropping Medicaid patients and this is preventing states from having tightened enrollment procedures in the wake of ongoing budget pressures.

States Desire Flexibility on Medicaid

A policy brief from Health Affairs explores some of the major ideas being discussed to restructure Medicaid and the competing arguments.

Physician Innovators Advice Sought on Improving Delivery of Care under Medicaid

The American Medical Association reports that physician innovators are being tapped to refine and share their ideas for improving the delivery of care under Medicare, Medicaid and the Children's Health Insurance Program.

Rejecting Medicaid Would Impose Higher Costs

Christopher Conover of the American Enterprise Institute argues that, while ObamaCare increases the economic burden compared to what would have happened before ObamaCare's Medicaid expansions begin, rejecting all federal Medicaid funding would impose obligations that are astronomically higher.

Massachusetts Health Experience: What the Nation Can Expect?

Health care reform in the United States may look a lot link what's happening in Massachusetts, according to a team of experts. The National Journal reports that the Massachusetts reforms, which were signed into law by Mitt Romney, have not gotten health insurance coverage to most of the state's residents.

Dartmouth Study to Analyze Geographic Differences

Researchers with the Dartmouth Atlas Project will analyze geographic differences in health care for patients insured by Medicaid and commercial insurance. According to Modern Health Care, they plan to use Medicaid and commercial insurance data to study children's healthcare variation in three Northeastern states.

State News

California: A federal judge in California has temporarily blocked a 10 percent cut to California's Medicaid rates that the Obama administration approved in October.

Georgia: A long-awaited state-commissioned report calls for Georgia to consider adopting an enhanced managed care system, Medicaid ''redesign'' initiative, for its Medicaid and PeachCare populations.

Hawaii's Medicaid program has awarded contracts to five health care organizations to administer programs for low-income residents.

North Carolina: The nonprofit Community Care of North Carolina network estimated a cumulative $984 million in Medicaid savings from 2007 to 2010.

North Carolina's Medicaid medical home program saved nearly $1 billion in state and federal spending over four years, largely by reducing hospitalizations and emergency department visits.

Florida Gov. Rick Scott wants to cut rapidly growing Medicaid spending by nearly 10 percent this year to free up funds for education.

New Jersey: A dental operation is turning a profit by focusing on Medicaid recipients.

Texas: Johnson & Johnson agreed to settle a Medicaid fraud lawsuit brought by the state for $158 million.

Utah: A state lawmaker has proposed imposing a higher copayment for tobacco-using residents enrolled in Medicaid.

Be Prepared

Order a copy of the NCPA Handbook on State Health Care Reform here.

Sign up for John Goodman's health policy blog at:

Take Advantage of the NCPA's Medicaid Service Center. The Medicaid Service Center can help state-based think tanks with commentaries, policy papers and speakers for briefings. Those interested in exploring further should contact Devon Herrick at (972) 308-6470.

Links of Interest

What the Other Side Says

The NCPA welcomes submissions of Medicaid-related research for inclusion in future editions.


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