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Life Health > Health Insurance

On the Third Hand: Medicaid enrollment

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The Republican governors who, deep down, opposed using Patient Protection and Affordable Care Act (PPACA) Medicaid expansion money simply because they hate the idea of President Obama and other Democrats succeeding with implementing any legislation of any kind have been acting in a less than warmly attractive bipartisan spirit.

But, at the same time, those governors raised two important questions: How stable will the federal Medicaid expansion funding really be? And, even with the help of various PPACA provisions intended to increase the supply of health care providers, how prepared is the Medicaid provider community to care for an influx of people with new Medicaid coverage?

Will PPACA improve the health of the new Medicaid enrollees enough to offset any additional care they may now use because they have coverage, rather than go through life uninsured?

The Kaiser Family Foundation has come out with a new report on PPACA and Medicaid spending. In that report, analysts show that Medicaid enrollment and Medicaid spending are likely to increase about 18 percent in federal fiscal year 2015, which started Oct. 1.

The analysts found that enrollment will go up just 5.2 percent in states that rejected Medicaid expansion money. In those states, total spending will increase 6.5 percent, the analysts say.

On the one hand, from the perspective of someone who’s open to the idea that it’s reasonable for the government to get involved with paying for health care for poor people, it seems as if Medicaid expansion is a worthy experiment. The only way to find out whether Medicaid expansion really saves the country, as a whole, money or improves the quality of care poor people get is to try it. Certainly, whether a state manages to use extra Medicaid money to get more of its poor uninsured people covered is an indicator of that state’s fitness to govern itself.

On the other hand, as with the PPACA public exchange plan system, the performance of enrollment systems and the actual enrollment numbers are just early indicators of basic program manager competence. If the government provides extra money for health coverage programs, someone is bound to notice that money sooner or later and use it. 

On the third hand, the true indicators of success are the same as they were in 2008, when Obama and members of Congress began sketching out the proposals that became PPACA: Do the PPACA exchange system, the PPACA Medicaid expansion program and the PPACA commercial health insurance market rules hold down costs enough that the country can meet the demand for health care services in a reasonable, sustainable way, over the long haul, without leading to a death spiral among the private players and impossible, escalating demands for cash from taxpayers?

Many hospitals in Medicaid expansion states have published data on increases in the percentage of patients with some kind of health coverage, for example. At this point, I have not seen any good data on how well or how quickly the payers for the newly covered patients are paying.

Similarly, we have data showing that millions of people have signed up for health coverage through the PPACA public exchange system, and millions more through private exchanges, but we have little lay-friendly data on how high or how low the actual claims are compared with what insurers had expected.

Even when we get the early claims data, those numbers may reflect startup issues, not how PPACA would work (or not work) if it were all grown up. Measuring the full effects of PPACA (or lack of effects of PPACA) on people’s health and overall use of care is like measuring the effects of any other wellness program: The process may take years, or decades.

To me, one conclusion seems clear: People who speak confidently about either the failure or success of the PPACA coverage expansion programs probably have an ax to grind.

The people who are trying to look at this with open minds stutter a lot, pull out their rapidly graying hair, and hope the eye protection vitamins from the health food store will protect their eyes from the effects of reading too many 2015 health insurance rating filing PDFs.


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