How Does Medicaid Do in Closing the Gaps? (original) (raw)
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Moving Ahead Amid Fiscal Challenges: A Look at Medicaid Spending, Coverage and Policy Trends
Medicaid/CHIP, 2011
Medicaid staffs in virtually every state have seen administrative budgets trimmed and workloads increase as ongoing budget shortfalls have increasingly affected state governments. Especially in this year, we thank the public servants who administer the nation's Medicaid programs in all 50 states and the District of Columbia who completed the survey on which this study is based, provided information about their programs, participated in structured interviews and responded to our follow-up questions. Without the help of these Medicaid officials, this study could not be done. Given the challenges these staff are facing, we are truly grateful for their assistance. We offer special thanks to Dennis Roberts at Health Management Associates who developed and managed the database. His work is always excellent and for several years has been invaluable to our work on this survey. Cathy Rudd from Health Management Associates assisted with writing the case studies and we thank her for her excellent work.
Enrollment Is Driving Medicaid Costs--But Two Targets Can Yield Savings
Health Affairs, 2009
This paper examines various reasons for the growth in Medicaid spending in the current decade. Although Medicaid spending has grown faster than the rate of increase in national health spending, much of this is explained by increased enrollment. Per enrollee, Medicaid spending actually compares favorably to increases in medical care prices and gross domestic product. The relative success in Medicaid cost containment seems to be attributable to limits on provider payment rates, expansion of managed care, limits on the use and pricing of prescription drugs, and expansion of community-based long-term care programs. We suggest two strategies for further cost containment. [Health Aff I n t h e f i r s t y e a r o f p r e s i d e n t b a r ac k o b a m a's t e r m , Americans' attention has turned again to health reform. One major topic in the reform debates of 2009 is the cost of public health insurance coverage. To inform these discussions, we analyze recent spending growth in the federal-state Medicaid program, which covers low-income and disabled Americans. Medicaid spending increased from 205.7billionin2000to205.7 billion in 2000 to 205.7billionin2000to330.8 billion in 2007-an average annual growth rate of 7.0 percent (Exhibit 1). In 2006, Medicaid prescription drug spending for dual eligibles (those eligible for both Medicare and Medicaid) was shifted to Medicare, which meant a one-time reduction in Medicaid spending and a lower rate of growth. After adjusting for this shift, Medicaid spending increased about 7.8 percent over this period. As we contend in this paper, Medicaid spending growth has largely been driven by enrollment and underlying health care inflation. Per enrollee, this growth, over and above increases in medical care prices or growth in gross domestic product (GDP), has been quite small. Nonetheless, there are still areas in which Medicaid spending growth could be better controlled. 1 4 5 6 S e p t e m b e r / O c t o b e r 2 0 0 9 L o o k i n g A h e a d on July 19, 2016 by HW Team Health Affairs by http://content.healthaffairs.org/ Downloaded from 1 4 5 8 S e p t e m b e r / O c t o b e r 2 0 0 9 L o o k i n g A h e a d on July 19, 2016 by HW Team Health Affairs by http://content.healthaffairs.org/ Downloaded from M e d i c a i d H E A LT H A F F A I R S~Vo l u m e 2 8 , N u m b e r 5 1 4 5 9 on July 19, 2016 by HW Team Health Affairs by http://content.healthaffairs.org/ Downloaded from 1 4 6 0 S e p t e m b e r / O c t o b e r 2 0 0 9
An Empirical Evaluation On The Effectiveness Of Medicaid Expansion Across 49 States
2020
In 2014 the Patient Protection and Affordable Care Act (ACA) introduced the expansion of Medicaid where states can opt to expand the eligibility for those in need of free health insurance. In this paper we attempt to assess the effectiveness of Medicaid expansion on health outcomes of state populations using Differencein-Difference (DD) regressions to seek for causal impacts of expanding Medicaid on health outcomes in 49 states. We find that in the time frame of 2013 to 2016, Medicaid expansion seems to have had no significant impact on the health outcomes of states that have chosen to expand.
2020
• The ACA significantly expanded insurance coverage between 2013 and 2017, but Americans' health worsened during this period as life expectancy declined for three consecutive years from 2014 to 2017. • States that did not adopt Medicaid expansion had favorable mortality trends from 2013 to 2017 compared with states that adopted the expansion, in part because they had fewer people die from opioid overdoses. • Medicaid expansion was associated with improvements in self-reported health and greater financial peace of mind, with mixed evidence on physical health benefits. It was associated with a decline in mortality for those near retirement age. • The bulk of the evidence suggests that targeted health programs, including those geared toward children, prove to be far better public investments than does a massive Medicaid expansion. • Large coverage expansions disappoint for several reasons: the uninsured receive nearly 80 percent as much care as similar insured people, the crowd-out of private coverage, and indirect effects on others such as longer wait times for care. 1 This study was peer-reviewed. 2 In 2013, the Congressional Budget Office (CBO) estimated there would be 25 million enrollees in the ACA exchanges in 2019. It turns out that there were fewer than 10 million (Congressional Budget Office 2020).
Health Status and Access to Care for the North Carolina Medicaid Gap Population
North Carolina Medical Journal, 2019
background North Carolina remains one of several states that has not expanded Medicaid eligibility criteria to cover all low-income adults, leading to the so-called Medicaid gap, a population ineligible for Medicaid and too poor for premium subsidies through the federal Health Insurance Marketplace. Our objective was to characterize the health care access and health status of the Medicaid gap population in North Carolina. methods We combined annual data from the Behavioral Risk Factor Surveillance Survey (2013-2016). Respondents who were uninsured and earning below 100% of the federal poverty guidelines (FPG) were classified as falling within the Medicaid gap and were compared to insured populations below FPG, representing the traditional Medicaid population, and to individuals above the FPG, regardless of insurance status. We reported health care access, receipt of preventive care, and current health status in unadjusted and demographically adjusted models. results Compared to either traditional Medicaid or above FPG groups, those in the Medicaid gap were 3 times as likely to have no regular source of care and twice as likely to report delaying needed care due to cost. Individuals in the Medicaid gap were more likely than individuals above FPG to report multiple chronic conditions (22% versus 16%) or a functional disability (35% versus 15%), but less likely than the traditional Medicaid population to do so. conclusion While less likely than the traditional Medicaid population to have complex health needs, we found that individuals in the North Carolina Medicaid gap report numerous health care access barriers and lower use of preventive care.
Three Papers Toward a Better Understanding of State Medicaid Programs and Program Efficiency
2016
First, I acknowledge the economics faculty at George Mason University, particularly my dissertation chair, Thomas Stratmann, as well as Alex Tabarrok and Bryan Caplan for teaching me about how to use economics to understand the world and think about public policy. The knowledge and skills that I have learned through George Mason University's economics program have been extremely valuable in my career as a policy analyst at the Heritage Foundation and now as the lead health care staffer for the House Committee on Oversight and Government Reform. I also acknowledge the valuable assistance and encouragement of Professor Stratmann as well as my dissertation advisors Professor Tabarrok, Len Nichols, and Robert Book which was necessary for the completion of my dissertation. I acknowledge the love, support, and encouragement of my parents. I also acknowledge the greatest gifts in my life-Evan, Spencer, and Andrewand I look forward to teaching them economics and especially about the law of unintended consequences. v
Health Services Research, 2007
Research Objective. This study investigates the impact of misreporting by Medicaid recipients on estimates of the uninsured in Louisiana, and is based on similar work by Call et al. in Minnesota and Klerman, Ringel, and Roth in California. With its unique charity hospital system, culture, and high poverty, Louisiana provides an interesting and unique context for examining Medicaid underreporting. Study Design. Results are based on a random sample of 2,985 Medicaid households. Respondents received a standard questionnaire to identify health insurance status, and individual records were matched to Medicaid enrollment data to identify misreporting. Data Sources. Data were collected by the Public Policy Research Lab at Louisiana State University using computer-assisted telephone interviewing. Using Medicaid enrollment data to obtain contact information, the Louisiana Health Insurance Survey was administered to 2,985 households containing Medicaid recipients. Matching responses on individuals from these households to Medicaid enrollment data yielded responses for 3,199 individuals. Conclusions. Results suggest relatively high rates of underreporting among Medicaid recipients in Louisiana for both children and adults. Given the very high proportion of Medicaid recipients in the population, this may translate up to a 3 percent bias in estimates of uninsured populations. Implications. Medicaid bias may be particularly pronounced in areas with high Medicaid enrollments. Misreporting rates and thus the bias in estimates of the uninsured may differ across areas of the United States with important consequences for Medicaid funding.
Inquiry : a journal of medical care organization, provision and financing, 2013
The expansion of Medicaid coverage under the Affordable Care Act offers the potential for significant increases in health care access, use, and spending for vulnerable nonelderly adults who are uninsured. Using pooled data from the Medical Expenditure Panel Survey, this study estimates the potential effects of Medicaid, controlling for individual and local community characteristics. Our findings project significant gains in health care access and use for uninsured adults who enroll in Medicaid coverage and have chronic health conditions and mental health conditions. With that increased use, annual per capita health care spending for those newly insured individuals (excluding out-of-pocket spending) is projected to grow from 2,677to2,677 to 2,677to6,370 in 2013 dollars, while their out-of-pocket spending would drop by $921. It is expected that these increases in spending would be offset at least in part by reductions in uncompensated care and charity care.