“The Affordable Care Act offered states a huge infusion of federal money to expand Medicaid eligibility to low-income adults, and about 30 states took that deal right away in 2014. Since then, new medical debt in those states has fallen 44 percent, a dramatically bigger drop than was seen in the states that refused to expand the program over the same period. Those states showed only a 10 percent decline.”
“nonmedical debt had fallen by similar amounts in expansion and non-expansion states over the time period they studied, 2009 to 2020, strengthening the case that Medicaid expansion was the difference with medical debt.”
“In states that expanded Medicaid, both the lowest- and highest-income groups saw their medical debt drop after expansion, but the amount of medical debt added annually decreased much more for the former (by $180, from $458 to $278) than the latter (by $35, from $95 to $60).
In non-expansion states, on the other hand, the lowest-income group averaged a $206 average increase in new medical debt, from $630 to $836. But the highest-income bracket still saw a small decline in new debt for medical care.”
“Those states are concentrated in the South. Eight of the 12 non-expansion states are in the region. Nearly one in four Southerners have some medical debt in collections listed on their credit report, compared to 10.8 percent of people in the Northeast and 12.7 percent in the West.”
“For many low-income people in the US, getting insured isn’t enough to get health care: Patients with Medicaid can struggle to find a doctor willing to take their health insurance.
And this happens in large part because, for doctors and providers, billing Medicaid is a pain.
A recent study by researchers from the US Bureau of Economic Analysis, the University of Chicago, and the Federal Reserve Bank in San Francisco found providers run into more obstacles when trying to bill Medicaid than they do with other insurers, and that these administrative hurdles explain the access problems experienced by Medicaid patients as much as the program’s payment rates.”
“About 19 percent of the initial claims submitted to Medicaid are not paid in full. For Medicare and for the private insurers, that share is much lower: 8 percent and 5 percent, respectively.
The health care providers then must invest time and money to sort out any rejected or disputed claims.”
“the study makes a strong case that solving access problems for Medicaid patients does not require jacking up the program’s payment rates, a difficult sell in a time of strained state budgets, in the country already with the world’s highest health care costs.
The researchers instead present this solution to the problem they identified: “To increase access to care, regulators could implement or require a simpler, cheaper administration of payment processes, without raising prices.”
So if we simply made it easier for doctors to receive payment for the services they provide, it could make a big difference for Medicaid patients.”
“nearly a decade after the Supreme Court ruled that states could choose whether to expand their Medicaid programs, the fight over whether to do so is far from over. So far, 38 states and Washington, DC, have expanded Medicaid, covering nearly 15 million people. In the dozen states that have not, 4 million people are uninsured who would receive Medicaid coverage if their state expanded eligibility under the ACA. More than 95 percent live in the South, they are disproportionately Black, and many are not eligible for subsidies to buy private coverage on the ACA markets.”
“The state, which has no income tax, pulls about a third of its budget from the federal government, a higher share than many other states, he said. That’s partly due to agricultural assistance and federal aid disbursed after natural disasters, but also because Texas has a large share of enrollees in entitlement programs like Medicaid.”
“examining how the rollout of Medicaid in the late 1960s affected people who were children at the time.
If you got health insurance through the program as a child, he found, you were less likely to die young; you were likelier to be employed and less likely to have a disability as an adult; and all these benefits actually wound up saving the government money.”
“Biden health officials have quietly revoked the previous administration’s approval of Medicaid work rules in two states, as they move quickly to unwind one of former President Donald Trump’s signature health policies.
Federal Medicaid officials on Wednesday sent letters to Arkansas and New Hampshire officials, informing them that the administration had formally scrapped the federal government’s permission for the states to mandate that some enrollees work, volunteer or attend school as a condition of coverage.”
“The Trump administration in 2018 issued guidance letting states, for the first time, to implement work rules in the Medicaid program, contending it would incentivize healthy people to find employment. Democrats argued the work rules were designed to shrink the safety net health program’s rolls, and courts have blocked the rules where they have been challenged.
The Biden administration last month began the process of eliminating work rules in the roughly dozen states where they had been approved. The states, which are predominantly Republican-led, were given until last Friday to submit information to CMS defending the work rules. In some states, Democratic governors inherited work rules from their GOP predecessors but sought to avoid enforcing them.”
“The Supreme Court is still weighing whether to review lower court rulings against work rules in Arkansas and New Hampshire, and revoking the programs could make the case moot.”
“For the second time this summer, voters in a solidly Republican state have decided now is the moment to expand Medicaid coverage through the Affordable Care Act.
Missouri voters passed a ballot initiative to expand Medicaid during Tuesday’s primary elections; 53 percent of voters supported the measure and 47 percent opposed it. That vote comes about a month after Oklahoma voters also decided to expand Medicaid via ballot referendum by less than 1 percentage point.
Once the expansion takes effect in those two states next year, an estimated 340,000 people who currently have no affordable health insurance option will become eligible for Medicaid. That still leaves nearly 2 million people in 12 states nationwide who are stuck in the Medicaid expansion gap — ineligible for coverage because their state refuses to expand the program but with an income too low to qualify for tax credits to buy private insurance — but it is yet another step toward the universal Medicaid expansion Obamacare authors envisioned. In the last few years, voters in Idaho, Maine, Nebraska, and Utah have also approved Medicaid expansion via ballot initiative.”
“programs for the poor are only a tiny portion of the U.S. welfare state. In fact, the Congressional Budget Office estimates that more than 60 percent of American households receive more in government benefits than they pay in taxes. To get an idea of just how big the American welfare state has become, consider that those transfer payments from the federal government are equal to 34 percent of all wages and taxes in the U.S.”
“The largest transfer programs are the middle-class entitlements, Social Security and Medicare. In addition, a large portion of the third biggest entitlement program, Medicaid, actually goes to the middle-class elderly and disabled individuals, not the poor. Those three programs alone now make up more than half of all federal spending.”
“we need to understand that, in practice, when an individual pays Social Security taxes, none of those taxes are set aside for that individual’s benefits. Rather, they are used to pay benefits to those who are currently retired. Social Security is merely a transfer payment from workers to retirees. In that sense, it operates exactly the same as any other transfer or welfare program.”
“Many individuals will receive more than taxes paid plus a reasonable amount of interest on those taxes.”
“according to the Social Security system’s trustees, the program faces a future shortfall of more than $43 trillion7 (measured in discounted present value over an infinite horizon—that is, if the government put away $43 trillion today and earned 3 percent interest on those funds, it would have enough money so that, combined with payroll taxes, it could pay all future benefits). Unfortunately, however, the federal government doesn’t have an extra $43 trillion. As a result, there is simply no way that Social Security can pay future benefits without a massive tax increase.”
““Cutting Medicaid — yeah,” Davidson said. “The head of CMS [the Centers for Medicare and Medicaid Services] announced the plan to let states file for waivers so they could get block grants, so that would essentially cut the amount of money going to states. So that would cut federal Medicaid funding.””
“”I think it comes down to that for the people I take care of all the time,” responded Davidson. “People I see in the emergency department that can’t get primary care doctors, [but] once they got Medicaid they could get primary care doctors. They stay out of the ER, they actually work more, they actually contributed to our community more.”
“Now, if you tell those people, ‘Sorry, you don’t get your health care’ — that’s going to be a real negative in their lives,” Davidson continued.”
“Obamacare’s Medicaid expansion, which gave millions of low-income adults access to health insurance, was linked to a 6 percent reduction in opioid overdose death rates — potentially preventing thousands of deaths — according to a new study in JAMA Network Open.
The study looked at what happened in counties in states that expanded Medicaid under the Affordable Care Act by 2017, compared to counties in states that didn’t expand Medicaid, accounting for variables like demographic and policy differences. The Medicaid expansion was made optional in a 2012 Supreme Court ruling, and only 32 states and Washington, DC, had opted to expand by the study period (with the total rising to 37 in the past few years).
The study helps put to rest claims by some Republican lawmakers, particularly Sen. Ron Johnson (WI), that the Medicaid expansion made the opioid crisis worse by expanding access to painkillers. The new study, echoing others before it, suggests the Medicaid expansion had the opposite effect, and that there wasn’t a link between the expansion and more deaths caused by painkillers, with the possible — and relatively uncommon — exception of methadone used in pain treatment.
The researchers found that Medicaid expansion counties had a 6 percent lower rate in opioid overdose deaths than non-expansion counties. That was mostly due to an 11 percent lower rate of deaths involving heroin and a 10 percent lower rate for deaths linked to synthetic opioids excluding methadone”