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Ala. governor eyes Medicaid expansion

Robert Bentley, M.D., the Republican governor of Alabama,  where the Affordable Care Act is often denounced, says that his administration might expand the state’s Medicaid program under the federal healthcare law. The expansion under the ACA has been blocked so far by conservative opposition.

“I am concerned about the plight of the working poor … If doctors are not paid for seeing those patients, doctors will not go to rural Alabama because you can’t expect a doctor to go to rural Alabama and lose money,” Dr. Bentley said.

If it actually happens, the move would bring Medicaid expansion  to the center of the Republican-dominated Deep South. It would also presumably be good news for the state’s providers.

The desire to obtain the federal funds for the Medicaid expansion has led a few Southern Republican leaders to  say they could support the expansion provided the states get waiver programs that give states some leeway to design their own programs. Expect to hear from more of them.

 


Feds wants more scrutiny of state Medicaid expansion plans

The Government Accountability Office and the federal advisory panel on Medicaid are pressing states to better document and report the extra payments to providers that fall outside the federal disproportionate-share hospital programs.

The GAO says weak documentation limits the Feds’ ability to make sure that the payments are efficient and  directly support Medicaid beneficiaries. Modern Healthcare reported that ”in one analysis, the agency found that supplemental payments to about 500 hospitals in 39 states exceeded the costs of caring for Medicaid patients by $2.7 billion. ”

The publication reported the GAO worried that states “are increasingly relying on collecting assessments from providers and local governments to draw federal matching dollars and create funding for enhanced Medicaid payments.”

 


Hospitals boost construction

construction

Construction work at Massachusetts General Hospital.

Modern Healthcare reports on what might surprise some folks given the challenges facing hospitals — a upsurge in building.

“Most of the focus has been on outpatient services as healthcare increasingly shifts to lower-cost-care settings. Health systems and hospital chains also are opening freestanding emergency departments to bring in additional volume. But even on the inpatient side, there’s a greater emphasis on service line planning as hospitals seek to become more competitive in high-margin specialties.”

“I’m not aware of any market where there’s not activity,” Dick Miller, president of Earl Swensson Associates, a Nashville-based architecture firm, told Modern Healthcare “It’s definitely picking up. There’s a lot of activity and a lot of it’s focused on outpatient” and specialty services.

There are signs that the Supreme Court’s 6-3 decision on Affordable Care Act subsidies  has accelerated building plans by removing a lot of uncertainty about future federal funds being available for hospitals through the ACA’s Medicaid expansion.
Projects, of course,  depend on local needs.” For instance, said  the publication,  “Rural hospitals, which serve an aging population, are adding skilled nursing and geri-pysch facilities, he said. In the suburbs, there’s demand for freestanding emergency departments to serve patients who don’t want to make the trek into the city for urgent care.”


Hospitals might be on hook for some Medicaid-expansion costs

 

Policymakers in Medicaid expansion states likely will try to extract some cash from hospitals starting in 2017 to help pay for the expansion. 2017 is when the federal government will no longer pay the full  bill for the coverage growth.
Higher-than-expected enrollment means that Medicaid expansion states will owe hundreds of millions  dollars more than they anticipated when they took advantage of the Affordable Care Act’s Medicaid expansion to adults earning up to 138 percent of the federal poverty level. So some states may try to get money from the hospitals to pay for the added expense.
Under the ACA, the Feds pick up the full cost for newly eligible adults through next year. After that, the match gradually drops to 90 percent by 2020.

Still, Medicaid expansion reduces state costs in other ways while boosting jobs and economies.

Modern Healthcare says one option is “to have hospitals contribute through the system of assessment fees already being collected by many states. Since the 1980s, provider assessments have generated billions of dollars to help states boost the matching funds they receive from the federal government. In 2015, 38 states had such levies in place, according to the Kaiser Family Foundation.”


Big hurdles for ACA lie ahead

hurdles

Herewith a look at the next five big hurdles for the Affordable Care Act. Although it won a major victory in last week’s Supreme Court ruling, its long-term future is not yet safe.

The hurdles, as discussed in MedScape are:

Medicaid Expansion.

Anemic Enrollment.

Market Stability. 

Affordability. 

Political Resistance.

 

 


Physician practices and the ACA: Seven statistics

 

Physician_in_hospital_sickroom_printed_1682 (1)

 

In Medicaid-expansion states

  • “Primary-care visits from Medicaid patients in expansion states increased from 15.6 percent in 2013 to 21.5 percent in 2015.
  • “Medicaid patients who were new in 2014, the first year of the {ACA} expansion, returned to the same practice at a higher rate than those who were new to Medicaid in 2013.
  • “Uninsured adult visits dropped 2.2 percentage points, from 4.6 percent in 2013 to 2.4 percent in 2015.
  • “Commercial visits decreased from 65.2 percent in 2013 to 62.8 percent in 2015 in expansion states.

Non-Medicaid-expansion states

  • “The proportion of visits from Medicaid patients to primary-care providers in non-expansion states dropped from 9.4 percent in 2013 to 8.9 percent in 2015.
  • “Uninsured adult visits dropped 1.5 percentage points between 2013 and 2015, from 7.2 percent to 5.7 percent.
  • ” Visits from commercially insured patients increased from 66.1 percent in 2013 to 68.1 percent in 2015.”

 

 


Healthcare fragmentation’s high cost

dollars

The Fiscal Times reports on a HealthAffairs analysis on the  vast administrative costs associated with the Affordable Care Act.

The analysis in HealthAffairs found that the ACA would add about $273.6 billion in administrative costs in  2014-22, including $172.2 billion in higher private insurance overhead.

David Himmelstein, M.D., and Steffie Woolhandler, M.D., professors at the City University of New York School of Public Health and lecturers at Harvard Medical School, cite  rising enrollment in private plans, the law’s Medicaid expansion and the cost of setting up and running health-insurance exchanges.

Instead of the ACA, it would have cheaper, easier and more efficient to simply extend the traditional Medicare program to everyone — but that was seen as ideologically and politically impossible. So we have a system whose fragmentation and contradictory incentives and disincentives maximizes costs as each constituency demands its cut.

The latest estimate means about $1,375 in extra administrative costs per newly insured person per year, according to the report. That’s “over and above what would have been expected had the law not been enacted,” Dr. Himmelstein wrote on the Health Affairs blog.

 

 

 

 


Arkansas to keep Medicaid-expansion private option for now

albie

In sign of how entrenched Medicaid expansion has become  even in some Tea Partyish states, Arkansas’s new Republican governor, Asa Hutchinson, has asked the legislature to keep the state’s ”private-option” approach to Medicaid expansion, backed by his Democratic predecessor, through 2016. Mr. Hutchinson doesn’t want to deal with the firestorm that would ensue if about 200,000 low-income residents lost access to insurance coverage that they had won through the Affordable Care Act.

But Hutchinson has proposed a legislative task force to study other options for insurance for low-income people. We wouldn’t be surprised if those options end up where many “blue-ribbon commissions” end up — the Bermuda Triangle.


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