Wednesday, June 3, 2009

“Around the Horn” with Medicaid Reform (06/03/2009)

hurricanesFor those of us who just can’t get enough health policy, why don’t we work off our seven-course meal from yesterday with a little baseball?

The first two positions below are not Medicaid-specific but right now,  they are doing all the pitching and catching and the rest of us (including Medicaid) are just waiting for the ball to go into play.

Pitcher – President Obama. Numerous media reports via the new Kaiser Health News service suggest that the Administration is not opposed to taxing at least some portion of health benefits in order to pay for health reform. Also, at, Karen Tumulty reports on a letter released by the White House to Congressional leaders that provides some additional clarity to the President’s position.  

300px-Sebastian_the_Ibis Catcher – Congress. Ezra Klein of the Washington Post notes that the notion of a public plan is going from bargaining chip to integral piece of reform. Interesting, see earlier MFP post on public plans here.

In the infield, we have a new package of resources from Kaiser Commission on Medicaid and the Uninsured.

  • 1st base - Medicaid as a Platform for Broader Health Reform: Supporting High-Need and Low-Income Populations. This paper summarizes the problems that low-income individuals face in today's health care system, describes the structure and coverage of Medicaid and explores how the program could be expanded to cover more people as part of health reform.
  • 2nd base - The Coverage and Cost Impacts of Expanding Medicaid. This paper quantifies the impacts on coverage and cost of expanding Medicaid to cover more of the low-income uninsured, including adults, at various income levels and with improved participation rates.
  • 3rd base - Expanding Health Coverage for Low-Income Adults: Filling the Gaps in Medicaid Eligibility. This policy brief reviews health coverage and key characteristics of non-elderly low-income adults and discusses the implications for national health reform of broadening Medicaid coverage for this population.
  • Shortstop - Community Care of North Carolina: Putting Health Reform Ideas into Practice in Medicaid. This brief examines the structure and experience of Community Care of North Carolina, an enhanced medical home model of care that the state adopted in its Medicaid program to improve care coordination and reduce costs for chronically ill beneficiaries.

In the outfield, we have more resources from KCMU:

  • Leftfield – CHIP Tips. A provision in the Children's Health Insurance Program Reauthorization Act of 2009 provides for a “bonus” to states that do an especially good job of signing up eligible children for Medicaid. Also, KMCU has updated data on CHIP expenditures (here).
  • Centerfield – Medicaid Physician Payment. From Kaiser’s website: “This study, published in a Health Affairs Web exclusive, provides the first national and state-by-state update of Medicaid physician fees since 2003.
    Medicaid has historically reimbursed physicians under fee-for-service at levels below what Medicare and private health insurers would pay for the same services. The study finds that Medicaid fees grew by more than 15 percent from 2003 to 2008, but fell in real terms because the gains did not keep pace with inflation. Medicaid fees did grow faster than Medicare fees during that period, however, rising from 69 percent of Medicare in 2003 to 72 percent by 2008.  Increases were greatest in Medicaid fees for primary care and obstetrical services.” For those that are interested, Kaiser has interactive tables that compare individual states to national averages (here) and individual states to Medicare (here). For example, here in the State of Florida, Medicaid basically pays physicians about 63% of Medicare and about 89% of the national Medicaid average.
  • Right Field – updated Federal Medical Assistance Percentage (FMAP). KMCU has also an updated interactive table for FMAP (here), which includes the additional assistance included in the “recovery act” (ARRA 2009). 

storyimage-image-7070_t_w600_h600Utility infielder - we have a dated but applicable article from the NYT via Kaiser that states continue to “cut off their nose to spite their face” due to budget pressures. The original NYT article included this telling quote from Linda Blessing, interim chief of the Arizona Department of Economic Security, "There's no question that we're getting short-term savings that will result in greater long-term human and financial costs," adding, "There are no good options, just less bad options."

Designated Hitter – also from Health Affairs we have the article “Beyond Parity: Primary Care Physicians' Perspectives on Access to Mental Health Care” by Peter Cunningham, which found that primary care doctors have a difficult time getting mental health services for their patients.

1419526547Closer – and finally, from The McKinsey Quarterly, we have the report “How health care costs contribute to income disparity in the United States.” I would expound on this but all you need to do is look at courses 3 through 5 from our seven course meal yesterday. Enjoy. ~BAA