Medicaid Expansion Now in States' Hands

Margaret Dick Tocknell, for HealthLeaders Media , July 6, 2012

Because the premium tax credit schedule for health insurance exchanges begins at 100%, Florida's decision not to expand its Medicaid program will leave an estimated 995,000 eligibles, whose incomes are less than 100% FPL, with no access to either tax credits or subsidies.

Nationally 11.5 million adults will find themselves in the same boat because their income is less than 100% of the FPL.

Reuben's group will also keep a close eye on efforts by the Centers for Medicare & Medicaid Services to encourage states to increase Medicaid coverage. "What kind of give and take is there between the federal government and state governments that would make it more interesting for states to expand Medicaid coverage?"

He points to Florida's Medicaid program, which currently operates under a CMS waiver. The state has asked CMS for a waiver to treat all Medicaid recipients under a managed care program. "That's an opportunity for some give and take."

DSH payments may present another opportunity for give and take. Disproportionate share hospital programs for facilities that treat a large number of indigent patients are embedded in the ACA, which provides the Department of Health and Human Services with the discretion to allocate the cuts.

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3 comments on "Medicaid Expansion Now in States' Hands"

R Daniel King (7/11/2012 at 9:34 AM)
TennCare expanded Medicaid eligibility utilizing HMOs that grew into a financial crisis resulting in stricter eligibility. With no significant change in enrollment costs grew 3.5 times from $2.4 billion in 1994 to $8.5 billion in 2005. Why? Program never inspired health care efficiencies and quality. In 2003, Dirigo Health in Maine was a subsidized health care premium program that was suppose to insure 130,000 within five years. Today, less than 10,000 are under the program. Why? Never inspired health care efficiencies and quality. Hawaii employer mandated insurance started in 1974 and by 1992 all but 2% were insured. The Clinton Administration granted Hawaii "Medicaid expansion" to cover the 2% which failed after 9 years. The mandate is killing small business and Hawaii now limits its mandate to full-time employees causing an increase in part-time employees increasing the uninsured to 10%. Why? Never inspired health care efficiencies and quality. And just because someone has insurance does not mean they avoid bankruptcy since a 2007 study found 75% of bankruptcies due to health care bills had insurance! ObamaCare disciples will ignore the above failures and facts, but some governors have the courage to remember. Although ObamaCare feels good, it remains a dead program spending until the nation replaces it with a system the inspires ALL health care professionals to be in the constant pursuit of the most efficient delivery of quality universal integrated care. Meanwhile, ObamaCare will prove to be an economic coffin that many governors will rush to occupy.

Don Stumpp (7/9/2012 at 10:25 AM)
Agreed Christine! In my opinion, this is the heart of ACA - The expansion of insurance benefits to those who have no coverage. I just hope that the States who opt out do so because it is best for their citizens - NOT because they dont want to give a victory to Obama or Democrats. Put politics aside and tell me: how will your citizens be served by opting out? Let's go through it. The uninsured poor (133% FPL) either get care or they dont. If they get care, they dont pay for it, and the insured pay for it or the government thru DSH funds or other mechanisms. If they dont get care, they suffer or eventually get care when it then becomes more costly. The States need to think of Medicaid expansion not as same-ol' same-ol' FFS increases. If more people get HEALTH care we can reduce overall costs of SICK care. Let me ask - if your providers went to not extending credit to consumers and therefore one needed insurance or cash (Visa/mastercard/Discover accepted!), what would happen? If healthcare became like every other industry and expected payment at time of service, the lack of insurance would be painfully apparent. Walmart, Kroger or your local pizza place doesnt finance your purchase. Why should doctors? Even when you go to the pharmacy for your Rx - it is payment at time of service to the penny for any of 10,000 drugs on the NDC. Twitter: Iam4ACA

Christine Hankerson (7/6/2012 at 11:15 AM)
Why is there such resistance from the states? Either way the tax payers incur costs. So why not allow individuals to have healthcare under this Act, take the burden off the emergency departments, and ultimately hope for a healther country.




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