More About Jesse Cross-Call

Jesse Cross-Call

Jesse Cross-Call is a Policy Analyst in the Health Policy division of the Center on Budget and Policy Priorities. In this role he examines issues related to the implementation of health reform and provides information and technical assistance to state and local officials, providers, and nonprofit organizations who are working on issues related to expanding coverage to the uninsured through Medicaid and the new health reform marketplaces.

Full bio and recent public appearances | Research archive at CBPP.org


Renew CHIP — And Sustain Children’s Health Coverage Gains

November 14, 2014 at 3:11 pm

The share of children without health insurance remained at a historic low of 7.1 percent in 2013, Georgetown University Center for Children and Families’ annual report on children’s health coverage finds (see graph).   That’s down considerably from the 9.3-percent rate for 2008, the earliest year for which we have comparable data.  (The small change from 2012’s 7.2-percent rate wasn’t statistically significant.)

Along with Medicaid, the Children’s Health Insurance Program (CHIP) has been a major factor in reducing the ranks of uninsured children since its enactment in 1997.  However, states will get no new federal CHIP funding after September 2015 unless Congress acts.

And without new CHIP funding, as many as 2 million children could lose health coverage and become uninsured, the Government Accountability Office (GAO) estimates.

Congress should act as soon as possible to extend federal CHIP funding.  Otherwise, it risks derailing these substantial gains in children’s health coverage.

States Can Stand Up for Veterans by Expanding Medicaid

November 10, 2014 at 12:37 pm

Roughly 215,000 veterans in 23 states are uninsured and denied Medicaid because their state has refused to take up health reform’s Medicaid expansion.  Half of them live in five states:  36,000 in Texas, 32,000 in Florida, 20,000 in Georgia, 17,000 in North Carolina, and 12,000 in Tennessee.

Most veterans get health coverage from their employer, but for those without access to job-based coverage, substantial gaps exist.  While some veterans receive coverage through the VA health system, not all qualify.

Health reform, however, has greatly expanded uninsured veterans’ access to health coverage.  Nearly 90 percent of non-elderly veterans who were uninsured before health reform would be eligible for Medicaid or subsidies to buy private coverage through the new insurance marketplaces, the Urban Institute projected in 2012 — if all states take up the Medicaid expansion.

Unfortunately, 23 states haven’t.  That’s left 215,000 of the nation’s poorest uninsured veterans in a coverage gap, where their income is too high for Medicaid under prior eligibility rules but too low for marketplace subsidies.

States that have expanded Medicaid are making the greatest progress in reducing the ranks of the uninsured, we’ve pointed out.  Meanwhile, states that haven’t taken up the expansion are denying health coverage for their poorest residents, including many uninsured men and women who have served our nation.

 

State Medicaid Spending Growing Slower in Expansion States Than Others

October 27, 2014 at 2:43 pm

States that have expanded Medicaid as part of health reform expect their share of Medicaid spending to grow more slowly this year than states that have not expanded, a new Kaiser Family Foundation report finds.  That’s yet more evidence that states are headed down divergent paths based on whether they have taken up the expansion.

The 28 states (including Washington, D.C.) that have expanded Medicaid or will expand it this fiscal year (2015) expect their Medicaid spending to grow by 4.4 percent this year, compared to 6.8 percent among non-expansion states, Kaiser’s annual survey finds (see graph).

What’s more, state Medicaid spending growth will actually slow in expansion states this year, down from 6.6 percent last year.  Meanwhile, non-expansion states expect a modest uptick in state spending growth from last year.

While benefiting from slower spending growth, expansion states are making substantial progress in reducing the ranks of the uninsured.  The uninsured rate among non-elderly adults has fallen by 38 percent in expansion states but only by 9 percent in non-expansion states, an Urban Institute survey found.  The fact that the federal government picks up the entire cost of newly eligible individuals under the expansion allows states to expand coverage while limiting their costs.

While the Kaiser report examined only state Medicaid budgets, it notes that expansion states also expect a more far-reaching positive impact on their overall finances:

States expanding Medicaid also typically cited net state budget savings beyond Medicaid.  States reported that expanded coverage through Medicaid could allow for reductions in state spending for services such as mental health, correctional health, state-funded programs for the uninsured and uncompensated care.

Indiana Should Revise Medicaid Waiver Proposal

October 17, 2014 at 11:01 am

Indiana has proposed to expand Medicaid and extend health coverage to as many as 374,000 uninsured Hoosiers through the Healthy Indiana Plan (HIP) 2.0.  As currently designed, however, the proposal would create barriers to coverage for low-income individuals and cause substantial numbers of people to remain uninsured, as we explain in a new paper.  The state should modify its proposal to ensure that all newly eligible adults are actually able to participate and receive necessary health care services on a timely basis.

HIP 2.0 would be a new demonstration project, or “waiver,” that incorporates features from the state’s existing Medicaid waiver, which was approved prior to the enactment of health reform and offers limited coverage to about 40,000 low-income adults.

Although Medicaid waivers give states additional flexibility in how they design their Medicaid programs, the Medicaid statute requires that waivers must test new approaches to Medicaid while promoting the program’s objective of delivering health care services to vulnerable populations that can’t otherwise afford care.  As proposed, HIP 2.0 falls short of meeting this standard in several important respects: aspects of the plan would almost certainly result in substantial numbers of low-income people being unable to receive health insurance and access care for significant periods of time.  Indiana should modify those parts of the proposal to ensure that newly eligible Medicaid beneficiaries can actually enroll in coverage and receive necessary health care services.

HIP 2.0 does drop some problematic features of the state’s existing Medicaid waiver, such as a cap on the number of enrollees and annual and lifetime dollar limits on coverage, to comply with changes that the health reform law made to Medicaid.  But the state is seeking approval to maintain certain other features of its current waiver that are inconsistent with the Medicaid expansion, such as charging premiums to people with little income and delaying the start date for coverage.  A substantial body of research, including Indiana’s own experience under its existing Medicaid waiver, demonstrates that charging premiums to people with low incomes discourages them from enrolling in and maintaining coverage.

Click here to read the full paper.

Hospitals Benefiting From Medicaid Expansion, Report Finds

September 5, 2014 at 10:52 am

Hospitals in states that have expanded Medicaid as part of health reform are seeing a large drop in uninsured patients and higher-than-expected revenues, a new report from the PricewaterhouseCoopers (PwC) Health Research Institute finds.  It’s the latest evidence of the Medicaid expansion’s benefits for states, their businesses, and their residents.

Examining financial data for the first half of the year from the country’s three largest health care providers, PwC found a 47 percent drop in admissions of uninsured patients at affiliated hospitals in Medicaid expansion states.  This suggests a sizable drop in uncompensated care — consistent with a nationwide survey of hospitals by the Colorado Hospital Association after the first quarter of the year.  PwC also found that the rise in the share of patients with health coverage boosted providers’ revenues even more than they had anticipated.

Meanwhile, the Urban Institute projects that hospitals in the 23 states that have not yet expanded Medicaid (see map) will lose out on $157 billion in reimbursements between 2013 and 2022.

This PwC report is one of several indicators of the growing gap between states that have expanded Medicaid and those that haven’t.  The Medicaid expansion is driving large gains in health coverage, while states that haven’t expanded risk forgoing those gains as well as millions of dollars in savings.