Thursday, June 4, 2015

Expanding Medicaid in Georgia

 WASHINGTON, DC (PR) - “The administration is willing to work with any state interested in expanding Medicaid, said Vikki Wachino Acting Director, Center for Medicaid and CHIP Services. “We are committed to supporting state flexibility and working with states on innovative solutions that expand Medicaid to low-income individuals in accordance with the law’s goals and consumer protections, while securing quality, affordable health coverage and growing a state’s economy.” The White House Council of Economic Advisers (CEA) released estimates of the health and economic benefits if Georgia decides to expand Medicaid under the Affordable Care Act (ACA).

As Chairman of the Council of Economic Advisers Jason Furman wrote, the report “leaves no doubt that the consequences of States’ decisions are far-reaching, with major implications for the health of their citizens and their economies.”

Georgia’s decisions to expand Medicaid would have major health benefits for its low-income citizens, including:

·         Greater insurance coverage: Expanding Medicaid will increase the number of the State’s citizens with insurance coverage. The report cites estimates that if Georgia expanded Medicaid, an additional 389,000 people would have insurance coverage in 2016.

·         Improved access to care: Expanding Medicaid improves access to needed medical services, including primary and preventive care. The report estimates the number of additional Georgia citizens that would get their cholesterol checked and receive a mammogram or pap smear each year. It also estimates the number of additional people who would receive all needed care and have a usual source of clinic care if Georgia expanded Medicaid.

·         Better health: By improving access to care, expanding coverage through Medicaid improves mental and physical health. The report estimates that if Georgia expanded Medicaid, 52,000 additional individuals would report being in good (or better) health and 36,000 fewer individuals would experience symptoms of depression.

·         Greater financial security: Expanding Medicaid reduces the risk of financial hardship due to sickness. The report estimates that if Georgia expanded Medicaid, 55,300 fewer people will have trouble paying other bills due to the burden of medical costs.

The report also finds that Georgia’s decision to expand Medicaid would generate important economic benefits:

·         A higher standard of living: States that expand Medicaid bring billions of dollars into their economies. That funding boosts the standard of living of the State’s citizens both by improving the lives of the newly-insured and by reducing the burden of uncompensated care for providers, taxpayers, and the privately insured. The report estimates that by not expanding Medicaid, Georgia will miss out on $2.85 billion in federal funding in 2016.

·         Lower uncompensated care: Uncompensated care costs would be $410 million lower in 2016 if expanded coverage was fully in effect in Georgia.

Thanks to the Affordable Care Act, states have new opportunities to expand Medicaid coverage to individuals with family incomes at or below 133 percent of the federal poverty level (generally $32,253 for a family of four in 2015). Health care costs for people made newly eligible through the Medicaid expansion is paid for with 100 percent federal funds in calendar years 2014‐2016, 95 percent in calendar year 2017, 94 percent in calendar year 2018, 93 percent in calendar year 2019, and 90 percent in calendar years 2020 and beyond.

A separate report released today by the U.S. Department of Health and Human Services (HHS) shows that 12.2 million additional Americans nationwide, including 193,450 people in Georgia, now have affordable health coverage through Medicaid and the Children’s Health Insurance Program (CHIP) in March 2015 compared to before the start of the first Marketplace open enrollment period in October 2013.  This monthly report also shows a state by state breakdown in enrollment increases as of March 2015. 

To date, 28 states plus DC have expanded Medicaid under the Affordable Care Act. However, 22 States—including many of the States that would benefit most—have not yet seized this opportunity (although Montana has passed legislation to expand Medicaid and is working with the Centers for Medicare and Medicaid Services to implement its expansion). 

Researchers at the Urban Institute estimate that, if these States do not change course, 4.3 million of their citizens will be deprived of health insurance coverage in 2016. 

Undocumented people are not included in the estimation since they can't access to the exchanges. These patients without health insurance rely on free clinics. There has been a doubling during the last decade in the number of U.S. medical schools that have student-run free clinics, with more than half of medical students involved with these clinics, according to a study in the December 10, 2014, issue of JAMA, a theme issue on medical education.

Playing Politics with ACA, Unhealthy for Americans? 

A Supreme Court ruling expected later this June that strikes at the heart of the Affordable Care Act would seem like a clear Republican victory. However, because such a ruling would have a profound impact on a number of crucial battleground states in 2016, the ruling could create a backlash against Republicans in states necessary to win the 2016 presidential election. 

Also, many of the state’s that would be most affected by an end to federal Obamacare subsidies are also states with key races for control of the U.S. Senate. Ironically, Republicans who have spent the past half-decade trying to repeal Obamacare, may soon discover that a Supreme Court decision in their favor will prove a weird victory that costs them control of the U.S. Senate.

If the Court decides the federal government is on the right side of the law, nothing happens; business continues as usual in all 50 states' ACA exchanges. People keep their insurance as is. But politically, an Obama administration win would mean volumes.

Subsidies allow customers in the insurance exchanges to pay less. But the Court will decide this month whether to strike down the subsidies in most states, including Georgia. These states let the federal government run their exchanges, and plaintiffs in the litigation say the ACA allows subsidies only in state-operated exchanges.

About 540,000 Georgians enrolled in plans on the exchange for 2015, and nine of 10 of them receive subsidies. If the subsidies go away, many people may drop out of the market. Insurers may have been anticipating just such an occurrence. 

This year’s health premiums showed only slight increases, and some rates actually declined. That was a reflection of increased competition over the previous year in the state’s insurance exchange. 

For 2016, the proposed hikes in Georgia are “larger than we’ve seen in the last four years,’’ according to health insurance experts. 

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