Medicaid Expansion

Jill Beiser, Kathleen Power, & Megan Reid

Problem Identification Patient Protection

and Affordable Care Act, aka Obamacare.

Affordable health insurance for ALL! Tax credits Tax breaks Health insurance

exchanges Choice of the States

- The Problem

Background - SocialEnacted in 1965 Initially, a medical care extension of

programs providing assistance for poor Emphasis on children, their mothers,

disabled, and elderlyGradually expanded Medicaid’s

beneficiaries from 4 million to nearly 60 million (Kaiser Commission, 2011)

Background - Economic Federal government pays a share of medical

assistance expendituresDetermined annually comparing state’s

average per capita income level with national income levelHigher per capita income level reimbursed

less Enrollment grown over 7 million since 2007 Major item in federal and state budget

3rd largest domestic program in federal 2nd largest program in most states

Background - EthicalEthical issues

Moral foundations, cost containment, public health, and access to care

Primary ethical issueDistributive justice

Is health care a right or an option?

Background - Legal Payment reform. New reimbursement structures. Access to program participation in Medicaid

and health insurance exchanges and products.

Background - Political Republican vs. Democratic views. Massachusetts’ formula. Where does Kansas stand?

Issue StatementHow can the federal and state

governments implement changes to Medicaid in order to provide adequate health insurance to impoverished citizens without causing the state or federal

governments unreasonable debt?

StakeholdersAll U.S. citizens under the age of 65

with family incomes < 133% of the federal poverty level (Medicaid, 2013)

Federal governmentStatesTaxpayersHospitalsPhysicians/NP’s/PA’s

Policy Objectives1) Expand Medicaid coverage to all

individuals up to age 65 with incomes <133 % of the federal poverty level

2) Establish policies at the state level that increase funding for Medicaid expansion in line with the ACA.

3) Develop legislation at the federal level and agreements between states to ensure short-term and long-term federal funding for Medicaid expansion

Policy Objectives cont.4) Structure priorities and policies at the

state level that reflect citizens needs and support expanded coverage while remaining financially sound.

5) States periodically update and refine their budget for Medicaid as the nature and cost of healthcare changes in order to maintain the same level of care for their citizens.

Policy Alternatives Do Nothing

Option Incremental

Change Option Major Change

Option

Evaluation Criteria 1) The probability of states being able to

support the financial responsibilities of decision about Medicaid expansion and alternatives.

2) The efficacy and affordability of proposed plan to the citizens of the United States.

3) The ability of the plan to meet the healthcare demand of current and future population needs.

4) Political feasibility for state and federal governments.

Analysis of Option 1: The Do Nothing Option

Criterion 1: States able to support financiallyPro: States avoid relying on federal moneyCon: Does not fix or help decrease cost

Criterion 2: Efficacy/affordability to citizensPro: Keep tax increases to a minimum and

allows states to focus on other prioritiesCon: Raise health insurance and decrease

insured

Analysis of Option 1: The Do Nothing Option

Criterion 3: Meet healthcare demandPro: Decrease strain on primary care

providersCon: Demand for healthcare unchanged

Criterion 4: Political FeasabilityPro: Follows current institutional structure

Government tends to favor status quo over changeCon: Acts against majorly agreed upon belief

that healthcare is a broken system

Analysis of Option 2: Incremental Change

Option Criterion 1: States able to support

financiallyPro: Allows states to receive some federal

fundingCon: If federal funding reneged, states

bear burden Criterion 2: Efficacy/affordability to

citizensPro: Increases access and minimizes costsCon: Less money to other priorities and

tax increases

Analysis of Option 2: Incremental Change

Option Criterion 3: Meet healthcare demandPro: Increased accessibility/affordability

and focus on preventionCon: Further shortage of PCPs, increased

strain, decreased hospital productivity Criterion 4: Political Feasibility

Pro: Allows for shared costs and independence of states

Con: Requires agreement and has less clear guidelines related to federal funding

Analysis of Option 3: Major Change Option

Criterion 1: States able to support financiallyPro: Increases federal fundingCon: Maximizes federal government spending

and may fall back onto states Criterion 2: Efficacy/affordability to citizens

Pro: More money to other state priorities, minimize tax increases, affordable health care

Con: May still lead to tax increases and increases to already insured plans

Analysis of Option 3: Major Change Option

Criterion 3: Meet healthcare demandPro: Increase in insuredCon: Does not address shortage of PCPs

Criterion 4: Political feasibilityPro: Realigns federal and state

responsibilities with use of increased federal matching

Con: Requires more stringent funding guidelines and requires agreement

Comparison of Policy Alternatives

Tie between Alternatives 2 and 3Alternative 2 is more politically

feasible but alternative 3 has stronger ability to meet current/future needs of U.S. citizens

Alternative 3 requires the most funding from federal government but frees states’ resources.

Comparison of Policy Alternatives

Do Nothing Option

Incremental Change Option

Major Change Option

CriteriaFunding + + ++Continuation of Funding

+ + +

Ability to Meet Current/Future Demands

- + ++

Political Feasibility

++ + -

4+/1- 4+/0- 5+/1-Score for Each Alternative

3 4 4

Summary/Recommendations

Medicaid expansion will provide eligibility to all people under 65 with incomes <133% of the (FPL).

Opens up eligibility to Millions of low-income adults without children, low-income parents, children who are now on CHIP

Expected to cover an additional 16 million people by 2019 (Kaiser, 2010).

RecommendationsAlternative 2, the Incremental Change

Option is more politically feasible A systems design would allow for sharing

between states and the federal government

Option 2 increases health insurance for millions of people

More focus on prevention means less visits to ER

References The Advisory Board Company. (2013). Where each state stands on ACA’s Medicaid expansion.

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Galewitz, P. (2012). Study: Nearly a third of doctors won’t see new Medicaid patients. Kaiser Health News. Retrieved February 6, 2013 from http://www.kaiserhealthnews.org/stories/2012/august/06/third-of-medicaid-doctors-say-no-new-patients.aspx

The Heritage Foundation. (2013). Medicaid expansion in Kansas: Impact and cost to taxpayers. Retrieved from http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/kansas.

Holahan, J. (2009). Alternatives for financing Medicaid expansions in health reform. Kaiser Commission on Medicaid and the Uninsured. Retrieved from

http://www.kff.org/healthreform/upload/8029.pdf

References Kansas Health Institute New Service. (2012). Brownback says no again to health insurance exchanges.

Retrieved from: http://www.khi.org/news/2012/nov/08/brownback-says-no-again-health-insurance-exchange/. Kaiser Commission. (2010). Medicaid coverage and spending in health reform: National and state-by-state

results for adults at or below 133% FPL. Retrieved from http://www.kff.org/healthreform/upload/medicaid-coverage-and-spending-in-health-reform-national-and-state-by-state-results-for-adults-at-or-below-133-fpl.pdf

Kaiser Commission. (2011). Medicaid and the uninsured. Retrieved from http://www.kff.org/medicaid/upload/8165.pdf

Kaiser Family Foundation (2012). The Health Reform Law’s Medicaid Expansion: A Guide to the Supreme Court Arguments. Retrieved March 5, 2013 from http://www.kff.org/healthreform/upload/8288.pdf.

Lachman, V. D. (2009). Ethical challenges in healthcare: Developing your moral compass. New York, NY: Springer.

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Medicaid (2013). HealthCare.gov. Retrieved February 5, 2013 from http://www.healthcare.gov/using-insurance/low-cost-care/medicaid/

National Association of Public Hospitals and Health Systems (2012). Medicaid expansion benefits everyone. Retrieved February 5, 2013 from http://www.naph.org/Homepage-Sections/Advocate/Medicaid-Expansion-Benefits-Everyone.aspx?FT=.pdf

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http://www.kff.org/medicaid/upload/8165.pdf Nordal, K.C. (2012). Healthcare reform: Implications for independent practice. Professional

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2167. The Patient Protection and Affordable Care Act, 42 U.S.C. 300gg et seq. (2010). Retrieved from

http://www.gpo.gov/fdsys/pkg/BILLS-111hr3590enr/pdf/BILLS-111hr3590enr.pdf Social Security Administration. (2012). Annual statistical supplement to the social security bulletin,

2011 (SSA Publication No. 13-11700). Washington DC. United States Census Bureau. (n.d.). Health insurance highlights: 2011. Retrieved from http://

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http://www.healthcare.gov/law/full/ U.S. News & World Report (2013). Is Medicaid expansion good for the states? Retrieved February

5, 2013 from http://www.usnews.com/debate-club/is-medicaid-expansion-good-for-the-states Wilson, M. (2013). Lawmakers urge final answer on Medicaid expansion. State house sound bites.

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QUESTIONS?