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Medicaid

Jane Richey / January 23, 2014

HHS Says More Eligible for Medicaid

The number of people determined to be eligible for low-income health insurance programs grew in the month of December, the halfway point for ObamaCare’s first enrollment period, according to federal health officials.

The Department of Health and Human Services (HHS) reported Wednesday that more than 6.3 million people were approved to receive either Medicaid or the Children’s Health Insurance Program (CHIP) between October and December.

Roughly 2.3 million of these verdicts occurred in December, a 20 percent increase over the previous month, officials said.

HHS used the data to argue that more states ought to expand their Medicaid programs using mostly federal dollars. That expansion was a mandatory part of the Affordable Care Act, but the Supreme Court made it optional.

Read more.

Jane Richey / January 7, 2014

Millionaires on Medicaid

Expanding Medicaid coverage to an estimated nine million more Americans—as mandated by the Affordable Care Act—reinforces the idea that Medicaid only serves the poor. That perception is not accurate. And it distracts from a looming budgetary threat to the program: long-term care.

More than two-thirds of annual spending on long-term care for the elderly is paid by state and federal governments, $60 billion of which flows from Medicaid. With 10,000 baby boomers reaching retirement age every day for the next 19 years, the Congressional Budget Office projects that spending on long-term care will more than double by 2050—to 3% of GDP from 1.3%.

We might accept these rising costs if benefits flowed only to the elderly poor, as originally intended. But that is not the case. Significant long-term care benefits flow to individuals in the top 20% of retirement earnings, enabled by Medicaid’s generous asset-exclusion limits.

In many states, an elderly person may own a home valued at $802,000, plus home furnishings, jewelry and an automobile of uncapped value while receiving long-term Medicaid support. In addition, they are allowed to have various life-insurance policies, retirement accounts with unlimited assets, $115,920 in assets for a spouse, income from Social Security, and a defined-benefit pension plan. By most standards, such a household would be considered wealthy.

Read more.

Jane Richey / November 21, 2013

Medicaid – a Placebo for the Poor

Many GOP governors have been criticized for refusing to participate in the wild and ill-conceived expansion of the Medicaid program under Obamacare. There is good reason. While the expansion is underwritten by the Federal government in the near term, in the out years the states will be forced to either have their budgets consumed by Medicaid or take the politically difficult step of raising the eligibility requirements to pre-Obamacare levels. The left has glommed onto this yet another example of the heartless GOP wanting to kill off the poor. For instance, this from Talking Points Memo:

Republican governors refusing generous federal funding to expand Medicaid under Obamacare will leave over five million low-income Americans without basic health benefits, according to a new study by the Kaiser Family Foundation (KFF).

Since the Supreme Court ruled Obamacare’s Medicaid expansion to be optional last summer,just 25 states and the District of Columbia have proceeded to implement expansion. Another 22 states have refused, while a handful still remain undecided. Unfortunately, poor Americans living in states that aren’t expanding Medicaid likely won’t be able to afford health insurance at all.

There is, however, a conservative critique to be made of Medicaid that has nothing to do with money or politics. There is no evidence that it is better than no coverage at all.

Recently, the Oregon Health Insurance Experiment has provided uniquely powerful evidence about the impact of Medicaid coverage on uninsured adults. The evidence is compelling because the study is a randomized controlled trial (RCT), the gold standard in research design. Taking advantage of a lottery held in Oregon in 2008 to allocate a limited number of new Medicaid “slots” for low-income, uninsured nonelderly adults, a team of researchers gathered data on access, utilization, and clinical health measures for both the adults who gained Medicaid through the lottery and the adults who did not. Two rounds of findings have been published in the New England Journal of Medicine, which can be summarized, in part, as follows:

What follows are the top line summary statements. You can read the back-up discussion at the link.

  • Medicaid increased access to care and health care use, and improved self-reported health.
  • Medicaid improved adults’ mental health markedly; Medicaid’s impact on physical health remains inconclusive.
  • Medicaid virtually eliminated catastrophic medical expenses.

While the recipients used more services, felt better about themselves, and avoided catastrophic medical expense, the single factor that was “inconclusive” was their actual health.

More details here.

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