Last week, Emma Sandoe and I wrote in the Health Affairs blog an outline on how to think about evaluating Medicaid buy-in proposals. We thought that as the primary season is opening up and the chaos in the individual market, that more states will start thinking about Medicaid buy-in options for the individual market. From here, the most critical thing in evaluating a Medicaid buy-in proposal is identifying what the sponsors are seeking to achieve with such a proposal. We think there are several goals that could be achieved via a Medicaid buy-in. Some of these goals may be in opposition to each other.
- Increase the value and breadth of coverage in the Individual Market
- Offer more options to people living in low competition regions
- Stabilize and improve the viability of the individual market by eating some strategic risk
- Lower premiums for individuals in the individual market
- Increase consumer protections in the individual market
- Leverage the current combined Medicaid and individual market power to push system delivery reforms.
The key challenge to evaluate any buy-in proposal is figuring out what it is trying to do. Once that is identified, the evaluation is fairly straightforward but if you are an advocate, please press your representatives to clearly articulate the problem that they are trying to solve with this policy. That is just good advice in general.
Percysowner
Off topic, by a bit, but what are your thoughts on Argle McBargle’s column from yesterday The truth about medical bankruptcies Most of me says that this is just her mouthing off, but I’d like someone I respect to answer her argument. So Dave? Or anybody else who knows?
lowtechcyclist
Off topic, but Wilbur Ross has made the official decision to ‘reinstate’ the citizenship question to the 2020 Census.
Duane
Most states aren’t trying to improve Medicaid for its citizens benefit, they’re trying to eliminate it. Stupid and evil is all it amounts to.
Raoul
Somewhat OT, but this is what has lil Marco in trouble in Florida. He proposes things, but the problem he is facing is that the answer to the question of what he is trying to solve is answered by ‘his own ass’ and everyone sees right through it.
Back on topic, this Medicaid thing is interesting. I’m not sure why I didn’t know about it till now, but while I care a lot about healthcare access, it has fallen fairly low in my day-to-day concerns (a privilege of living in MN and being able to afford my premiums — so far! A high priority is keeping MN Blue so that we don’t have our care options screwed by Rethugs).
I like how dryly the final bullet notes GOP intransigence + voter confusion, from the National Academy of State Health Plans:
Bob Hertz
Megan’s current article is paywalled away from me, but she has written about this three times before.
Her point has been that the number of people who go bankrupt with some medical bills is high, but the numbers who are driven to bankruptcy by medical bills alone is smaller and not easily determined.
Bankruptcies occur mainly when people have high debt, no savings, and lose their jobs. Canada has plenty of bankruptcies despite no hospital or doctor bills for anyone.
A fully free national health plan in the US would cost $3 trillion a year and require payroll or income taxes of at least 16%. This is too much to spend to maybe prevent 250,000 bankruptcies.