302 research outputs found
Medicaid Expansion in Texas: What's at Stake?
Texas is one of nearly 20 states yet to expand its Medicaid program under the Affordable Care Act (ACA), and is home to the largest number of uninsured Americans of any state in the country. For many of the state's 5 million uninsured, this decision has left them without an option for affordable health insurance. A comparison with other Southern states that have expanded Medicaid shows how this decision has left many low-income Texans less able to afford their medical bills, to pay for needed prescription drugs, and to obtain regular care for chronic conditions. These problems have been compounded by the state's opposition to outreach and enrollment assistance for many Texans who are eligible for coverage under the ACA. Ongoing efforts from stakeholders and consumer groups to persuade state leaders to expand coverage have significant implications for the well-being of millions of low-income adults in Texas
Issues in health reform: How changes in eligibility may move millions back and forth between Medicaid and insurance exchanges
The Affordable Care Act will extend health insurance coverage by both expanding Medicaid eligibility and offering premium subsidies for the purchase of private health insurance through state health insurance exchanges. But by definition, eligibility for these programs is sensitive to income and can change over time with fluctuating income and changes in family composition. The law specifies no minimum enrollment period, and subsidy levels will also change as income rises and falls. Using national survey data, we estimate that within six months, more than 35 percent of all adults with family incomes below 200 percent of the federal poverty level will experience a shift in eligibility from Medicaid to an insurance exchange, or the reverse; within a year, 50 percent, or 28 million, will. To minimize the effect on continuity and quality of care, states and the federal government should adopt strategies to reduce the frequency of coverage transitions and to mitigate the disruptions caused by those transitions. Options include establishing a minimum guaranteed eligibility period and “dually certifying” some plans to serve both Medicaid and exchange enrollees
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The Policy Argument for Healthcare Workforce Diversity
This perspectives article considers the potential implications an affirmative action ban would have on patient care in the US. A physician’s race and ethnicity are among the strongest predictors of specialty choice and whether or not a physician cares for Medicaid and uninsured populations. Taking this into account, research suggests that an affirmative action ban in university admissions would sharply reduce the supply of primary care physicians to Medicaid and uninsured populations over the coming decade. Our article compares current conditions to the potential effect of an affirmative action ban by projecting how many future medical students will become primary care physicians for Medicaid and uninsured patients by 2025. Based on previous evidence and current medical student training patterns, we project that a ban could deny primary care access for 1.25 million of our nation’s most vulnerable patients, considerably worsening existing healthcare disparities. More broadly, we argue that the effects of eliminating affirmative action would be fundamentally contrary to the Association of American Medical Colleges’ stated goal of medical education—“to improve the health of all.
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Measuring Medicaid Physician Participation Rates & Implications for Policy
Policymakers continue to debate Medicaid expansion under the ACA, and concerns remain about low provider participation in the program. However, there has been little research on how various measures of physician participation may reflect different elements of capacity for care within the Medicaid program, and how these distinct measures correlate with one another across states. Our objective was to describe several alternative measures of provider participation in Medicaid using recently publicly available data; to compare state rankings across these different metrics; and to discuss potential advantages and disadvantages of each measure for research and policy purposes. Overall, we find that Medicaid participation as measured by raw percentages of physicians taking new Medicaid patients is only weakly correlated with population-based measures that account for both participation rates and the numbers of physicians per capita or physicians per Medicaid beneficiary. Participation rates for all physicians versus primary care physicians also offer different information about state-level provider capacity. Policymakers should consider multiple dimensions of provider access in assessing policy options in Medicaid, and further research is needed to evaluate the linkages between these provider-based measures and beneficiaries’ perceptions of access to care in the program
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Federal Funding Insulated State Budgets From Increased Spending Related To Medicaid Expansion
As states weigh whether to expand Medicaid under the Affordable Care Act (ACA) and Medicaid reform remains a priority for some federal lawmakers, fiscal considerations loom large. As part of the ACA’s expansion of eligibility for Medicaid, the federal government paid for 100 percent of the costs for newly eligible Medicaid enrollees for the period 2014–16. In 2017 states will pay some of the costs for new enrollees, with each participating state’s share rising to 10 percent by 2020. States continue to pay their traditional Medicaid share (roughly 25–50 percent, depending on the state) for previously eligible enrollees. We used data for fiscal years 2010–15 from the National Association of State Budget Officers and a difference-in-differences framework to assess the effects of the expansion’s first two fiscal years. We found that the expansion led to an 11.7 percent increase in overall spending on Medicaid, which was accompanied by a 12.2 percent increase in spending from federal funds. There were no significant increases in spending from state funds as a result of the expansion, nor any significant reductions in spending on education or other programs. States’ advance budget projections were also reasonably accurate in the aggregate, with no significant differences between the projected levels of federal, state, and Medicaid spending and the actual expenses as measured at the end of the fiscal year
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On the Outskirts of National Health Reform: A Comparative Assessment of Health Insurance and Access to Care in Puerto Rico and the United States
Context: Puerto Rico is the U.S.’s largest territory, home to nearly 4 million American
citizens. Yet it has remained largely on the outskirts of U.S. health policy, including the
Affordable Care Act (ACA). This paper presents an overview of Puerto Rico’s health
care system and a comparative analysis of coverage and access to care in Puerto Rico
versus the mainland U.S.
Methods:
We analyzed 2011-2012 data from the Behavioral Risk Factor and Surveillance System,
and 2012 data from the American Community Survey and its counterpart the Puerto
Rican Community Survey. Among adults 18 and over, we examined the following
outcomes: health insurance coverage; access measures such as having a usual source of
care and cost-related delays in care; self-reported health; and the receipt of recommended
preventive services such as cancer screening and glucose testing. We used multivariate
regression models to compare Puerto Rico and the U.S., adjusted for age, income,
race/ethnicity, and other demographic variables.
Findings: Uninsured rates were significantly lower in Puerto Rico (unadjusted 7.4% vs.
15%, adjusted difference -12.0%, p<0.001). Medicaid was far more common in Puerto
Rico. Puerto Rican residents were more likely than those in the mainland U.S. to have a
usual source of care and a check-up within the past year, and fewer experienced costrelated
delays in care. Screening rates for diabetes, mammograms, and Pap smears were
comparable or better in Puerto Rico, while colonoscopy rates were lower. Self-reported
health was slightly worse, while obesity and smoking rates were lower.
Conclusions: Despite its far poorer population, Puerto Rico outperforms the mainland
U.S. on several measures of coverage and access. However, Congressional policies
capping federal Medicaid funds to the territory have contributed to budgetary challenges.
While the ACA significantly increases federal resources in Puerto Rico, ongoing
restrictions on Medicaid funding and premium tax credits pose substantial health policy
challenges in the territory
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Access and Quality of Care by Insurance Type for Low-Income Adults Before the Affordable Care Act
Objectives. To compare access to care and perceived health care quality by insurance type among low-income adults in 3 southern US states, before Medicaid expansion under the Affordable Care Act.
Methods. We conducted a telephone survey in 2013 of 2765 low-income US citizens, aged 19 to 64 years, in Arkansas, Kentucky, and Texas. We compared 11 measures of access and quality of care for respondents with Medicaid, private insurance, Medicare, and no insurance with adjustment for sociodemographics and health status.
Results. Low-income adults with Medicaid, private insurance, and Medicare reported significantly better health care access and quality than uninsured individuals. Medicaid beneficiaries reported greater difficulty accessing specialists but less risk of high out-of-pocket spending than those with private insurance. For other outcomes, Medicaid and private coverage performed similarly.
Conclusions. Low-income adults with insurance report significantly greater access and quality of care than uninsured adults, regardless of whether they have private or public insurance. Access to specialty care in Medicaid may require policy attention.
Public Health Implications. Many states are still considering whether to expand Medicaid under the Affordable Care Act and whether to pursue alternative models for coverage expansion. Our results suggest that access to quality health care will improve under the Affordable Care Act's coverage expansions, regardless of the type of coverage
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