Remember that after the Affordable Care Act passed, numerous commentators predicted that increased insurance coverage, achieved through purchase of individual plans through the ACA marketplace or expanded Medicaid coverage, would precipitate a primary care shortage? Experts feared that those with new coverage would not actually have access to care and those previously insured might experience decreased access to primary care. Studies have shown that primary care availability hasn’t suffered as expected.

Remember that after the Affordable Care Act passed, numerous commentators predicted that increased insurance coverage, achieved through purchase of individual plans through the ACA marketplace or expanded Medicaid coverage, would precipitate a primary care shortage? Experts feared that those with new coverage would not actually have access to care and those previously insured might experience decreased access to primary care. Studies have shown that primary care availability hasn’t suffered as expected.

The bill proposed this week by Senators Graham and Cassidy would repeal many provisions of the  Affordable Care Act and redesign the Medicaid program. Through 2026 the federal government would  provide each state a block grant in lieu of funding for Medicaid expansion and subsidies for health insurance purchased through the ACA marketplaces. Federal funding for Medicaid, absent the expansion, would be converted to a per capita cap basis, reducing federal expenditures over time. After 2026, the block grant would disappear. The bill would also eliminate consumer insurance protections of the ACA including prohibitions against annual and lifetime limits and underwriting practices related to pre-existing conditions.  

In Washington, the philosophical and political questions about the future of health care in the U.S. are swirling. A House bill to repeal and replace the Affordable Care Act and change Medicaid financing was considered early in 2017 and failed. Notably absent from the debate surrounding this bill was how to fix the underlying cost drivers of health care. If and when other proposals are considered, the question of cost drivers will likely be absent from those debates as well. The action to tackle affordability is in the states. Medicaid directors are transforming the way health care is paid for and delivered to contain costs and improve health outcomes. This transformation is taking place in partnership with consumers, providers and other payers.

Proceedings of the Medicaid 201 Leadership Policy Academy, Sept. 13-15, 2017

 

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CSG South

A vital tool for policymakers across the region, Comparative Data Reports (CDRs) offer a snapshot of conditions on a number of issues. Published annually, the CDRs track a multitude of revenue sources, appropriations levels, and performance measures in Southern states, and provide a useful tool to state government officials and staff.

The latest version of the Senate’s Better Care Reconciliation Act, or BCRA, was released July 20, 2017. According to the CBO analysis, the new version of the BCRA would reduce federal deficits by $420 billion over the 2017-2026 period, the net result of a direct spending decrease of $903 billion partially offset by a $483 billion decrease in revenues. Of special interest to states, the reduction in Medicaid spending is $772 billion, or 85 percent of the reduced spending, directly impacting states’ budgets. The effects of the bill on the number of uninsured is little changed from the earlier version. In 2018, 15 million more people would be uninsured than under current law and would reach 22 million in 2026.

Last week in Washington, D.C. 27 state legislative leaders gathered for the sixth annual CSG Medicaid 101 Policy Academy. Attention was focused on the Medicaid reform plan, called the Better Care Reconciliation Act of 2017, under consideration in the U.S. Senate following the House approval of the American Health Care Act in early May. CSG prepared a brief side-by-side comparison of the...

The president's federal budget was released May 23 and the analysis of winners and losers began practically before the ink was dry, although almost all of Washington seemed to agree the budget was dead on arrival. Cuts to the Medicaid and Children's Health Insurance Program, or CHIP, alone total $616 billion over the next ten years. The budget also envisions saving $250 billion from partly repealing and replacing the 2010 health care law. Taken together, these Medicaid cuts are nearly half the nondefense discretionary funding cuts. To further understand just how important federal Medicaid funds are to states, CSG looked at 2017 federal funding flowing to the states. According to Federal Funds Information for the States, or FFIS, data, the federal Medicaid funding for 2017 is more than 50 percent of all federal grant funds flowing to states in all but four states.

Medicaid Infographic

Medicaid is the second largest source of health care insurance in the United States, serving over 74.5 million people in some of our most vulnerable communities. Coverage is provided to low-income children, adults, seniors, and people with disabilities. Many Medicaid enrollees would be uninsured or underinsured without this coverage. The Medicaid program is funded with a combination of federal and state funds, with more federal participation in states with fewer fiscal resources.

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