Thursday, October 31, 2013
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Thursday, October 17, 2013
Study: Medicaid stance to push 400,000 Georgians into insurance gap
Study: Medicaid stance to push 400,000 Georgians into insurance gap
BY RICHARD HALICKS -
THE ATLANTA JOURNAL-CONSTITUTION
The state’s decision not to expand Medicaid under the Affordable Care Act will push more than 400,000 Georgians into a coverage gap in which they don’t qualify for Medicaid but also can’t afford to buy private health insurance, a new report said Wednesday.
The Kaiser Family Foundation’s report is less revelation than confirmation of what experts in the state have predicted. But it underscores that, for a large group in Georgia, Obamacare will have little meaning.
“The problem is that some of these individuals are going to need health care and they are going to continue to wind up in emergency rooms and at physicians’ offices with no way to pay for the care that they need,” said Bill Custer, a health care expert at Georgia State University.
“That care will continue to be paid for by local taxpayers and by people who do buy health insurance and pay for health care.”
The health care law sought to provide health insurance to nearly all the 49 million Americans who don’t have it. The law envisioned that the lowest-income people would go onto a massively expanded Medicaid program; moderate-income people with no insurance would shop on the Health Insurance Marketplace and, in many cases, qualify for a federal tax credit.
The Supreme Court ruled last year, however, that the federal government may not compel states to expand Medicaid. Twenty-six states opted out, and one of the pillars of Obamacare dissolved for half the country. As a result, people who earn between 100 percent and 400 percent of the federal poverty level can shop on the new insurance marketplace and potentially qualify for a federal subsidy. But people who earn less than 100 percent of the poverty level can’t, because the law assumed they would go on Medicaid.
More than 5 million people in the states that have declined to expand Medicaid will fall into the resulting coverage gap, Kaiser’s report said, with the greatest numbers in Texas, Florida and Georgia.
Rachel Garfield, senior researcher with the Kaiser Family Foundation, said the study’s goal was “to put a number on something people have been talking about for a long time: who’s falling through the cracks?”
Garfield said that 31 percent of the state’s uninsured adults would fall into the coverage gap.
The Kaiser Family Foundation, a respected source of independent information on health care, is not connected to Kaiser Permanente, the insurer.
Custer, at Georgia State, has been using state-level census data to study the state’s uninsured population. He has concluded that the Medicaid decision here will result in 400,000 to 500,000 being pushed into the coverage gap.
The federal government will pay 100 percent of the cost of the Medicaid expansion for three years, decreasing to 90 percent in later years. Gov. Nathan Deal maintains the longer-term costs to the state would be untenable.
Wednesday, October 16, 2013
Tuesday, October 15, 2013
Monday, October 14, 2013
Lew Lays Out Impact of Debt Ceiling Inaction on Medicare, Medicaid
Lew Lays Out Impact of Debt Ceiling Inaction on Medicare, Medicaid
By John Reichard, CQ HealthBeat Editor
A debt ceiling deal may be in the works but it isn’t done yet, and any agreement may not last long. What would happen to Medicare and Medicaid if lawmakers don’t increase the nation’s borrowing power?
Judging from a Senate Finance Committee hearing this week, the answer is likely a big interruption in cash flow and sharply lower rates of payment.
The federal government “has numerous large payments that are due shortly after Oct. 17, when we will have exhausted our borrowing authority and will only have cash on hand to meet our obligations,” Treasury Secretary Jacob J. Lew testified on Thursday. In the last two weeks of October, “we have large payments to Medicare providers, Social Security beneficiaries, and veterans, as well as salaries for active duty members of the military.” These could be delayed, he said.
“Doctors receiving reimbursements under Medicare would likely continue to provide services on a timely basis, but they would be operating with significant uncertainty about when they would be paid by the government for their services,” he said.
“For millions of low-income Americans who rely on Medicaid for their health care, the federal government’s payments to states for the federal contribution would likely also be impacted. These providers still have to pay their doctors, nurses, and staff. But absent timely federal payments, many could face real liquidity challenges.”
Medicare beneficiaries could be hard hit in other ways, through delayed payments of Social Security checks and shrinking 401(k)s leaving them less able to pay for basic needs.
“For those waiting on benefits who need those funds to in order to refill their refrigerator, if that money doesn’t flow, they won’t go to that grocery store to shop.”
Lew noted that during the 2008 financial crisis retirements assets shrank. “Now if you create a crisis that causes assets to shrink in value, for retirees, they don’t have a lot of time to catch up.”
Lew did not dispute an assessment by the panel’s chairman Sen. Max Baucus, D-Mont., that payments by Medicare and other federal programs could fall to 70 to 80 percent of their current rates.
Lew rejected the idea advanced by some GOP lawmakers that the impact of failing to raise the debt ceiling could be reduced by paying some creditors and delaying payments to others.
“How can the United States United States
Republicans didn’t dispute Lew’s assessment of the impact of failing to lift the debt ceiling. But they bridled at his description of the current crisis as “manufactured,” saying Democrats have repeatedly failed to curb spending and that entitlement spending is on an unsustainable path.
“I think this is a manufactured crisis because we didn’t work on it yesterday,” said Sen. Michael B. Enzi, R-Wyo.
Sunday, October 13, 2013
Thursday, October 10, 2013
Are We Overmedicating Foster Care Children?
Are We Overmedicating Foster Care Children?
A new GAO report finds that states don't do a particularly effective job of monitoring kids on psychotropic meds.
BY: JONATHAN WALTERS | OCTOBER 8, 2013 GOVERNING MAGAZINE
Mental health issues are front and center in human services. Every day, caseworkers work in an environment where mental health services aren't as robust as they should be and where medication for kids in custody sometimes serves as a substitute for more appropriate care.
A good example of this is in New York
Of course, concerns over the use of medication among foster children certainly aren't exclusive to New York
Psychotropic meds, which are used to manage mood and behavioral disorders, can be effective, but the GAO report notes that using them wisely and well takes skill and close monitoring. And according to the GAO, kids who are prescribed medication don't usually receive timely follow-up visits. Furthermore, "mental health researchers and others have stated that there is a need for further research on the safety and effectiveness of anti-psychotics for children," the report's authors wrote, "particularly long-term effects."
Dorothy Miller and Kathleen Noonan, researchers with PolicyLab, the policy research arm of the Children'sHospital of Philadelphia
Miller and Noonan agree with the GAO report's findings: The extent to which states do a good job of monitoring and tracking is very uneven. It is especially uneven in states where human services are administered by counties with state oversight, they note. But there are states that have become models for how to deal with the issue. Miller and Noonan point to Texas
Legislation signed by Gov. Rick Perry that went into effect last month expands oversight of psychotropic medication in two ways. First, the law requires that kids who've been prescribed medication be seen by their prescribing physician at least every 90 days. Second, the legislation requires that judges overseeing a child's foster care case be informed of behavioral and pharmacological treatments at all court hearings.
While it is clearly important to focus on the complicated mix of drugs and kids, perhaps it is more important to focus on the issue of mental health overall. The GAO report notes that "30 percent of foster children with a potential mental health need had not received any mental health services within the previous 12 months or since the start of the child's living arrangement, if less than 12 months."
There are lots of reasons for this, not the least of which is a lack of skilled mental health care professionals willing to deal with a population that's typically covered only by Medicaid. But some states are tackling that larger issue. Massachusetts ' Child Psychiatry Access Program and Washington
Still, we are way behind in providing the sort of appropriate, high-quality mental health services that will be necessary in the long run if we're going to really help kids escape multigenerational cycles of state involvement.
CDC Scales Back Surveillance Efforts in Face of Shutdown
CDC Scales Back Surveillance Efforts in Face of Shutdown
By Rebecca Adams, CQ HealthBeat Associate Editor
The government shutdown has forced the Centers for Disease Control and Prevention to dramatically scale back its monitoring of illnesses nationally and across the globe as well as its assistance to local health departments, agency director Tom Frieden said Tuesday.
“From outside of the agency, it may be very hard to understand just how incredibly disruptive this is for our efforts to protect Americans,” Frieden told HealthBeat in an interview.
Since the government shut down on Oct. 1, House Republicans passed stand-alone continuing funding bills for the National Institutes of Health and the Food and Drug Administration. They have not yet passed a separate continuing resolution for the CDC, although some House Republicans say they want to do so.
“We do not have a commitment yet” from House GOP leadership for a floor vote on a CDC funding measure, said Rep.Jack Kingston, R-Ga., who chairs the appropriations subcommittee that oversees Department of Health and Human Services funding and is pushing for a vote on a continuing resolution for the CDC. “I hope would happen sooner rather than later. A lot of it just depends on the calendar and the evolution of discussions. So as things develop, the leadership knows of my desire to move it. I think they’re sympathetic to it but they’re looking at some mega-picture scheduling issues.”
As far as the overall budget negotiations go, Kingston
Senate Democrats and President Barack Obama have said they won’t accept a piecemeal approach to reopening the government and there is no indication when the House may pass a comprehensive funding resolution that Democrats will accept.
More than two-thirds of CDC employees — almost 9,000 people — were furloughed because of the shutdown. Overall, 52 percent of the Department of Health and Human Services was furloughed.
One example of problems that the CDC is not able to handle as fully as usual is a recent outbreak of salmonella that started in California
What worries Frieden most is the uncertainty of whether the government is missing another major disease outbreak or other threat.
“We’ve got free-floating anxiety,” said Frieden, adding, “Where is there a problem that’s spreading that we’re not recognizing?”
The agency has suspended the daily updates on global outbreaks it provides to other federal officials involved in public health and emergency response.
A telephone hotline for the public to report concerns about disease that routinely fielded 100 questions a day is now closed, Frieden said.
Nine of 10 global disease detection systems around the world have shut down, said CDC spokeswoman Barbara Reynolds. In a typical year, the centers respond to about 200 outbreaks and detect 6 to 10 new pathogens. Officials are particularly concerned about threats such as Ebola and new pathogens such as MERS-CoV and H7N9 flu that are circulating around the globe. But the centers — scattered throughout Latin America, Central Asia, Southeast Asia, the Middle East, South Africa Republic of Georgia
At international ports within the United States
About 85 percent of the CDC’s officials who monitor the spread of influenza throughout the nation are furloughed. The agency will no longer be able to produce its weekly snapshots informing medical providers and government officials where the outbreak is worsening, which can affect the distribution of flu shots and other supplies.
For some of the CDC’s operations, a couple of weeks of lost data can skew the results for an entire year.
Frieden likened the problem to one of a huge ship in the ocean that loses its navigational system. A couple of days without surveillance is a manageable.
“But if you lose it for a week or two, you can get very off track and it can get dangerous,” he said.
For every day that passes, Frieden and his top officials are reassessing whether they have the legal justification to bring back some furloughed workers.
“The challenge is this balancing act,” Frieden said. “We have to obey the law and have to do everything we can to protect people’s lives at the same time.”
For instance, the CDC is scheduled to inspect some labs that work with dangerous pathogens. “Do we do that or not?” Frieden said.
Tuesday, October 8, 2013
Does Big Exchange Turnout Include the Young and Healthy?
Does Big Exchange Turnout Include the Young and Healthy?
By John Reichard, CQ HealthBeat Editor
A constant thread through analysts’ comments about the early interest in health insurance exchanges is that there are many more shoppers than anyone expected. Does that mean many young and healthy people are shopping? Insurance industry sources aren’t embracing that theory yet. And a definitive answer probably won’t come before January, they add.
Some in the industry are skeptical that the figures on visits to insurance exchange websites are a true reflection of the level of interest. For example, when the administration estimated last week that there have been 7 million unique visits tohealthcare.gov, consultant Robert Laszewski said any claim that seven million people have visited “is not taken seriously” in the industry.
And there is “no way to know how many are healthy.” Laszewski added.
“I think that those who are claiming that the number indicates an early success of the program are fully of sound and fury indicating nothing,” added a managed care industry executive who requested anonymity in order to speak more freely.
The figure “is not a number that indicates anything reliable because it includes duplicate log-ins, people who lost connectivity, curiosity seekers, and the media,” the executive said. “Regarding the ages of those who eventually enroll, it will probably take until January of 2014 until anyone gets a sense of the demographics.”
Laszewski likewise advanced the view that the totals are heavily inflated by multiple visits by the same people. But that’s strongly disputed by Health and Human Services officials who suggest that the actual number of different people coming tohealthcare.gov is close to the number of unique visits — and certainly not something far less.
However, consultant John Gorman of the Gorman Health Group said Monday that there likely are many young and healthy Americans looking over the new marketplaces.
“I’m sure there’s plenty of them among those eight million unique visitors,” he said. “The question is how many of them are among the completed and effective applications. We’re not going to know that for weeks, possibly months.”
Gorman points to surveys showing that as many two-thirds of the so-called young invincibles “are going to really look at it. Interestingly, a huge impact on that segment is going to come between Thanksgiving and Christmas literally from their parents nagging them when they go home for the holidays.”
Gorman added that “I’m not as pessimistic as many others are out there that these folks will get frustrated and won’t come back. These are not people shopping for a plane ticket or a big screen TV. This is health insurance. They will come back.”
Minor Medicaid Enrollment Growth Precedes Big Increase in 2014
Minor Medicaid Enrollment Growth Precedes Big Increase in 2014
By Rebecca Adams, CQ HealthBeat Associate Editor
The growth in Medicaid enrollment slowed to 2.5 percent in fiscal 2013, the lowest rate of growth in six years, just before enrollment is expected to swell, according to a new report by the nonpartisan Kaiser Family Foundation.
Enrollment growth in 2014 is expected to balloon by 8.8 percent on average, said the report, which was prepared with the help of Health Management Associates.
The growth in fiscal 2014 is due to the health care law. Some of the increase will come about because about half of the states have decided to broaden eligibility next year, but more people are expected to enroll even in states that will not expand Medicaid because they will learn that they qualify for benefits under the traditional Medicaid program.
Total federal and state Medicaid spending increased at an average annual rate of 3.8 percent across all states, which the report called “relatively modest compared to historical growth rates.” The state share of Medicaid spending increased by 3.1 percent in fiscal 2013.
Until the health care law benefits kick in, state Medicaid programs have been banned by federal law from making eligibility cuts. A total of 18 states actually increased eligibility or made enrollment changes that benefitted applicants during fiscal 2013, said the report. Five states with a budget deficit cut back on eligibility in fiscal 2013 for adults with incomes above 133 percent of the poverty line. Those kinds of cuts were allowed under the law.
Medicaid provides health and long-term care coverage to more than 66 million low-income people in the United States
Kaiser report (PDF) (sent yesterday)
Monday, October 7, 2013
Friday, October 4, 2013
Thursday, October 3, 2013
Wednesday, October 2, 2013
Tuesday, October 1, 2013
Survey Shows Confusion Over Health Care Law but Support for Medicaid Expansion
Survey Shows Confusion Over Health Care Law but Support for Medicaid Expansion
Jane Bornemeier The New York Times
A day before the new health care exchanges open across the country, a new report shows that the more people understand it, the more they’re inclined to participate. But while most people are aware of the law’s requirement to buy insurance or face a penalty, a much smaller number have any understanding of the insurance exchanges opening on Tuesday or of the financial aid available to help people buy insurance.
The findings, by The Commonwealth Fund, indicate that the Obama administration still has a long way to go to make the law’s complicated provisions clear to prospective buyers.
The study also shows strong support for Medicaid expansion, even though many states – mostly in the country’s more conservative regions, like the South and Midwest — chose not to participate in the expansion after the Supreme Court ruled earlier this year they could not be compelled to.
Officials in states opting out of Medicaid, Florida and Texas
The telephone survey was conducted using landlines and cellphones between July and September of this year with more than 6,000 adults, ages 19 to 64. It is part of the foundation’s effort to track the health care law as it goes into effect.
Among the findings:
• Only 32 percent of people without health coverage during the last year were aware of the marketplaces.
• Thirty-one percent of people without coverage were aware of the subsidies that are available.
• Just under one-third (32 percent) of adults with incomes under 250 percent of the federal poverty level ($28,725 for an individual and $58,875 for a family) were aware of the subsidies, compared to 47 percent of those with higher incomes.
• Only 32 percent of people without health coverage during the last year were aware of the marketplaces.
• Thirty-one percent of people without coverage were aware of the subsidies that are available.
• Just under one-third (32 percent) of adults with incomes under 250 percent of the federal poverty level ($28,725 for an individual and $58,875 for a family) were aware of the subsidies, compared to 47 percent of those with higher incomes.
The survey found that once people were made aware of the marketplaces, 61 percent of those who are potentially eligible — because they were either uninsured at the time of the survey or had purchased an individual insurance plan — said they were very or somewhat likely to shop for coverage on the exchanges.
Only a slight majority (55 percent) of young adults aged 19 to 29 who are potentially eligible for the coverage options said they were very or somewhat likely to use the marketplaces, compared to 65 percent of those ages 30 to 49.
Potentially eligible adults with health problems were slightly more likely to say they would use the marketplaces than adults with no health problems (65 percent vs. 57 percent). Nearly equal shares of potentially eligible people who identify themselves as Democrats or Republicans said they were very or somewhat likely to shop in the marketplaces (67 percent vs. 63 percent), though Democrats expressed somewhat stronger interest.
Though only 25 states and the District of Columbia
The report also found that:
• Seventy-eight percent of people without insurance for a time during the last year, and 82 percent of people earning less than $32,499 a year for a family of four, support expanding Medicaid to more people in their state.
• Ninety-one percent of uninsured Democrats, 78 percent of uninsured Independents and 73 percent of uninsured Republicans strongly or somewhat favor their state making Medicaid available to more residents.
• Ninety percent of Democrats, 79 percent of Independents and 75 percent of Republicans making less than $32,499 a year for a family of four are in favor of making Medicaid available to more people.
• Seventy-eight percent of people without insurance for a time during the last year, and 82 percent of people earning less than $32,499 a year for a family of four, support expanding Medicaid to more people in their state.
• Ninety-one percent of uninsured Democrats, 78 percent of uninsured Independents and 73 percent of uninsured Republicans strongly or somewhat favor their state making Medicaid available to more residents.
• Ninety percent of Democrats, 79 percent of Independents and 75 percent of Republicans making less than $32,499 a year for a family of four are in favor of making Medicaid available to more people.
While 85 percent of adults surveyed did not know what their state had decided regarding the Medicaid expansion, among those who did, two-thirds (68 percent) of those who were aware their state was expanding Medicaid were in favor of that decision. Only 38 percent of adults who knew their state was not expanding Medicaid were strongly or somewhat in favor of that decision.