I’m a little late on this but Louisiana is set to expand Medicaid with a go-live date of July 1. They are able to go relatively fast because they are just doing a straight up expansion. There are some significant back end plumbing tasks that need to be hammered out before expansion (risk sharing, risk adjustment and risk corridors are the biggest ones) but the mechanics of issuing an ID card, setting up an appointment and paying a claim will be straightforward.
On his first full day in office, Democratic Gov. John Bel Edwards reversed course from his Republican predecessor Tuesday and started the process of expanding Louisiana’s Medicaid program….
The new governor said he wants to have government-funded health insurance cards in more people’s hands by July 1. It wasn’t immediately clear whether the state’s majority-Republican Legislature will try to create roadblocks to that goal….
The Edwards administration estimates that 300,000 more people, mainly the working poor, will be added to Louisiana’s Medicaid program under the expansion, which covers adults making up to 138 percent of the federal poverty level — about $33,400 for a family of four.
It has to get through the legislature but it should be a state budget cost saver in the short term so for a state in a budget crisis, this is an easy partial fix.
There are two other pieces of Medicaid expansion news worth talking about as well. The first is that the Obama Administration is trying to sweeten the pot for expansion on the hold-out states (via NY TIMES):
Obama’s new proposal would give states more time to opt in, and would pay for the expansion for three years, the White House said in a release.
Under current law, the Federal government paid 100% of Medicaid expansion costs for three calendar years (2014, 2015, 2016). If a state did not start expansion until 1/1/16, they only get a single free year before they have to kick in their cost sharing. Under this proposal, any state will get three years of expansion funded 100% by the Feds no matter when they start. I like this move. I don’t think it will be sufficient to get too many states on board as the states with a coalition of Democrats plus Republicans who can count to eleven with their shoes on is being tapped out. It would make Expansion more attractive to oil patch states that are hitting tough budgetary times due to the oil bust but that is where the ideological opposition is the strongest.
Realistically, the hardest hold-out states won’t go for Expansion with Obama in office unless the Legacy Medicaid match rate was significantly increased. That would be shoveling hundreds of millions of federal dollars to displace scarce state funds. But Congress won’t approve that.
The other Medicaid note is that the form of expansion does not matter much. Straight expansion with new ID cards is cheaper, more straightforward, less confusing and easier to run. The 1115 waiver expansions are more complicated and administratively complex and thus more expensive. However the Commonwealth Fund is seeing that beneficiaries’ health impacts aren’t changed by the form of expansion:
Low-income adults in Kentucky and Arkansas, which both expanded Medicaid eligibility under the Affordable Care Act, were more likely to be insured and less likely to have problems paying medical bills or affording prescriptions than low-income adults in Texas, which did not expand Medicaid….
Both traditional Medicaid expansion and the private option, which uses federal funds to purchase private plans, improve the likelihood that low-income adults will be able to get insurance coverage, afford needed health care, and obtain regular care for chronic conditions.
This was the result that the Obama HHS was counting on when they approved the waivers — they’re a decent political work-around and they’ll be significantly better than non-Expansion.
Baud
Elections matter.
OzarkHillbilly
HOORAY!!! My Baton Rouge waiter son and his waiter GF will finally be able to access health care on a regular basis.
Thoughtful Today
Richard,
Could you point me to a source you consider reliable that regularly updates the number of Americans that are not insured?
Is it still over 20 million uninsured Americans? 30 million?
And do those numbers exclude/include the undocumented?
Richard Mayhew
@Thoughtful Today:
US Census data: http://www.census.gov/hhes/www/hlthins/
Upside is that it is accurate and very detailed so slice and dice however you want, downside it is slow
Gallup: http://www.gallup.com/poll/188045/uninsured-rate-fourth-quarter-2015.aspx?g_source=Healthcare&g_medium=newsfeed&g_campaign=tiles
Quarterly, all adults, 11.9% 19-64 uninsured in most recent report
MomSense
I don’t even think the threat of impeachment will be enough for LePage to do the right thing for the people of Maine.
Baud
@MomSense: What a horrible person he is.
MomSense
@Baud:
He really is. He already made food stamps conditional on working or volunteering. Problem is there aren’t any jobs and if you can’t afford food, you might not be able to afford the transportation or daycare to get to a volunteer gig.
OzarkHillbilly
@MomSense: Elections have consequences.
rikyrah
300,000 of my fellow citizens will now have access to healthcare.
Bravo.
Elections matter.
MomSense
@OzarkHillbilly:
So do vanity candidates.
WaterGirl
@MomSense: So disheartening. I feel your pain. Always the optimist, I cannot believe that IL elected Bruce Rauer. I can barely stand to write his name. Elections matter, indeed.
WaterGirl
@MomSense: That’s horrible. At least in IL we have a legislature that can stop some of the damage.
These people have no empathy. I was picking up a prescription a few years ago and they were turning away the person in front of me because she forgot her insurance card. She was terribly sick, as was her daughter, and they wanted her to turn around, take 2 buses home and 2 more buses back. Screw them, I just paid for her medicine outright.
Seriously, I know there are sociopaths with no feelings out there, but how did it get to be an epidemic?
japa21
This question is only tangentially related to the post. Medicare adjusts its payments according to the geographical area a provider is in due to different cost levels in different areas.
However, it seems to me that the federal poverty level is the same nationwide. The question would be why. Obviously, the cost of living is much higher in some areas than others. $33,400 is going to get you a lot less in NY than in Louisiana. Wouldn’t it be better to have the poverty level dependent upon where one lives?
And no, I am not saying the $33,400 shouldn’t be the level in LA and that it should be lower. Rather, I think that the lowest cost of living areas should be our starting point at the current level and then adjusted upwards from there dependent upon cost of living in other areas.
Just a thought.
But then again, maybe that is already done, in which case, forget everything I just wrote.
japa21
@WaterGirl: I was watching an interview with Rauner on the anniversary of his first year in office. Had to work hard not to throw up. And the big money boys are going to go all out this year to give him a Republican legislature to work with.
His approval ratings are pathetic right now. If I was in charge of the Dems in Illinois, I would make it clear that a vote for any GOPer for the legislature is the same as a vote for Rauner.
MomSense
@WaterGirl:
I think sociopathy is rewarded in our society. It certainly isn’t punished (Ex. A Snyder). I can’t understand why anyone would set out to deny people access to see a doctor or want people to go to bed hungry. It’s like they read Dickens and liked the wrong characters.
OzarkHillbilly
@WaterGirl: My wife and I did the same for a woman in Baton Rouge who was trying to come up with the money for her child’s prescription out of her change jar.
Patricia Kayden
Well, this is some good news. Thanks Obama!!
Patricia Kayden
@MomSense: Why do the people of Maine keep reelecting him? In democracies, you get the government you deserve. Every time I hear about LePage, it’s something negative (and mostly racist).
Zinsky
I have yet to have a conservative explain to me why having an unhealthy population without access to decent, affordable health care is good for us as a country. Even if it means – horrors! – paying a little more in taxes.
Thoughtful Today
Richard,
Thank you.
jharp
So what is the better deal for states?
A straight up expansion like Louisiana?
Or an expansion like Indiana?
Thanks in advance for any help.
rikyrah
@jharp:
Not Mayhew, but states like Indiana, they are all about the bullshyt in using the expansion to try and punish poor people before they can get their Medicaid.
Maybe I’m wrong and Mayhew will correct me, but that’s how I interpret states like Indiana.
MomSense
@Patricia Kayden:
Two races with three candidates. The independent and the democratic candidates split the vote. LePage has never won with a majority of voters.
Richard Mayhew
@jharp: Really depends on your point of view.
From a straight up budgetary sense, a simple expansion costs less because it is administratively simpler so it is better for the state when they have to pick up a percentage of the costs.
However, from the POV of Republican office holders, an Indiana or Arkansas style expansion allows for expansion to occur without inviting a massive primary campaign against them as they did not expand Medicaid, they did something super special and sparkly to spite Obama.
From the POV of a resident of a state who is Medicaid expansion eligible, straight up expansion (either state FFS or Managed Care) is slightly preferable to the convoluted waiver versions of expansion as there are fewer barriers to care, but convoluted waiver is far more preferable than the status quo of either nothing, free care clinics of GFY
Mike in NC
Anybody know what wingnut welfare ex-governor Bobby Fucking Jindal is contemplating? Gig on FOX News maybe?
cmorenc
@Patricia Kayden:
Maine had its own version of a Ralph Nader 3P independent-in-the-race problem the two elections where LaPaige won with a plurality of around 40% of the vote – for this to happen, it takes a combination of individual savior-vanity by the independent candidate and perfect-is-enemy-of-the-good thinking by both the candidate and the voters who cast their votes for said 3P candidate. True, the way to eliminate the risk of an electoral system which enables a plurality to elect a candidate who’s toxic to the aggregate majority of the voting electorate that enables folks to vote for their true preference without risking this result (instant runoff format elections) will be fiercely resisted by the two entrenched establishment parties, precisely because of the substantial decrease in control over effective electoral choices and increased chance for rival third parties to become established.
The scary part is that around 40% of the Maine electorate (who voted) actually voted to re-elect this blatant asshole racist *after* seeing what his first term was like. This is a very repulsive reflection on the thinking and character of not just the 40% of voters who actually voted for LePage, but the portion of the electorate who did not bother to turn out to toss this assclown out of office.
Matt McIrvin
@cmorenc: Part of the problem was that in 2010, the independent was actually more popular than the Democrat, popular enough that both of them could plausibly say “no, YOU’RE the spoiler who should drop out.”
2014 was more of a Nader situation, though the independent was the same guy as before.
Felanius Kootea
Richard, just wanted to say thank you very much for your posts. I rarely comment on them but always appreciate them because I learn something new and valuable.
MomSense
@cmorenc:
Voter turnout was not the problem. It was up in our top five of voter turnout and we have historically high voter turnout compared to the rest of the country.
@Matt McIrvin:
Also, too Angus King dropped an endorsement for Cutler in the last 10 days of the 2010 election which meant that all the Dems who voted early couldn’t vote for the candidate who surged at the end.
This is why I’m volunteering for the ranked choice referendum question.
Shell
Three little words….
Suck it, Jindal!
Brendancalling
That’s awesome news for Louisiana! Hope Tennessee gets on board next.
Fake Irishman
Richard, didn’t the legislature already wash their hands of this last year and leave it up to the governor? I seem to recall they created a mechanism to fund their share of the expansion too. Comments?