Catching up – Days 26, 25, 24

Day 26 – Medicaid Makes a Difference!

“Does Medicaid Make a Difference” is the title of this excellent report by the Commonwealth Fund, which finds that the answer is a resounding “yes!!!!”. You should read it. The report is based on a survey of adults 19-64, and breaks out results by those who were insured all year with commercial insurance, insured all year with Medicaid, and those who were uninsured at some point during the year. Medicaid performed very well, on par with commercial insurance. A large majority of people with Medicaid coverage reported that they had a usual source of care, that their doctor knew the important points of their medical history, and that they’d had key screenings like blood pressure and cholesterol checks. It’s worth noting that 55% of the Medicaid group rated their care as excellent or very good. As we’ve discussed previously, Medicaid also did a good job of protecting people financially: people with Medicaid were much less likely than commercially insured to have problems paying their bills. Importantly, Medicaid enrollees were much less likely than the commercially insured to skip needed care because of cost.

Blumenthal_does_medicaid_make_a_difference_exhibit_01 Blumenthal_does_medicaid_make_a_difference_exhibit_05

Day 25 – Diabetes Management

dxandrx_sidebysideThe Commonwealth Fund report was based on survey data that told us some valuable information about patient’s perceptions of their health and insurance across commercial coverage, Medicaid, and those who were not fully insured. We return to our trusty friend, the Oregon Health Study, to see how RCT data backs up some of the patient reports about how Medicaid increased their access to care and use of necessary care. Consistent with the report above, RCT data found that enrolling in Medicaid increased the chances of being diagnosed *and* being treated for diabetes. The study did not show an effect on outcomes (ex. HbA1c), but this may be because a longer follow up is needed (the Oregon experiment ended because Medicaid kept expanding…a great reason!)

As we pass the midpoint of this series, it’s kind of cool to see patterns emerge….for instance, we are seeing mounting evidence that relative to being uninsured/underinsured, Medicaid is effective in increasing access to care, enabling use of necessary health services, and protection from financial hardship.

Day 25 – State Highlight: Kansas

Basics: KanCare covers 407,527 people

Kansas is in the middle of some interesting public policy experiments, and Medicaid expansion has been contentious. This past year, the legislature held its first hearings on Medicaid and had over 150 testmonies in support of expansion. Many leaders from across the Kansas community spoke, including Dr Robert Moser, who had recently stepped down from his post as secretary of health in the administration!

No action was taken after the hearing, but the state may take up the Medicaid question again next year, considering expansion for 2017. Kansas has been struggling with major budget shortfalls in the face of large tax cuts and the money that Medicaid would bring in could be very helpful. The fiscal pressure is growing and powerful stakeholders support expansion, but it will also be an election year, and Governor Sam Brownback and much of the Republican legislature have to date strongly opposed the Affordable Care Act. Kansas will be a state to watch.

Day 24 – State Highlight: Iowa

Basics: Iowa Medicaid covers 592,937 people

There is so much we could talk about when it comes to Iowa Medicaid. Iowa was one of the states who sought a private option for Medicaid. They were approved for section 1115 waivers as part of their participation in Medicaid expansion that allowed them to enroll people who were under 100% FPL (and who weren’t otherwise categorically eligible) in Medicaid (managed care) , and they created premium support for people 101-138% FPL to buy one of two participating qualified health plans (QHP) in the marketplace. However, they’ve already made some changes to the premium support concept. One of the two participating QHPs dropped out in late 2014, so people in that income range were given the option to enroll in a Medicaid managed care plan or stay in the remaining commercial plan. Starting in 2015 the default option for people 101-138% FPL is a Medicaid MCO, unless they want to opt into the QHP. The premium support model of Medicaid is new territory for everyone, and so it will be illuminating to see how it unfolds, including how it works for patients, and also how it works as a business model. It is a great time to be alive in health policy.


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