The Center's work on 'Health Reform' Issues


Further Health Coverage Gains, Especially in Medicaid Expansion States

December 17, 2014 at 2:08 pm

The number of uninsured Americans fell by 6.8 million over the first two quarters of 2014, preliminary data from the Centers for Disease Control and Prevention’s (CDC) National Health Interview Survey show.  These are the most up-to-date government survey data on the early impacts of health reform’s major coverage expansions, which took effect in January.  And they show a widening coverage gap between states that have adopted health reform’s Medicaid expansion and other states.

Superseding earlier CDC estimates, the new figures that the CDC released yesterday include the second quarter of 2014, when enrollment surged in state Medicaid programs and health reform marketplaces.  Together, the two reports show consistent progress across the year in reducing the ranks of the uninsured.

Some 12.2 percent of Americans were uninsured in the first six months of 2014, the CDC data show, a 2.2 percentage-point decline from 2013 and the lowest rate since the CDC first collected these data in 1997.  The uninsured rate has fallen by nearly a quarter since peaking at 16.0 percent in 2010.

Coverage gains were greatest among the population groups that have been least likely to have coverage.  The uninsured rate for people in families between 100 and 200 percent of the poverty line plummeted from 29.3 percent to 24.1 percent between 2013 and the first half of 2014.  Adults under age 26, Latinos, African Americans, and people with less than a high school education also experienced disproportionate gains.

Coverage gains among non-elderly adults were nearly twice as large in states that have expanded Medicaid as in non-expansion states, widening the gap between the uninsured rates in the two groups of states from 4.3 percentage points to 6.1 percentage points.  (See graph.)  Several more states are considering adopting the expansion, which would lead to further coverage gains.

The new CDC figures are consistent with four independent surveys showing significant coverage gains in 2014, particularly among Medicaid expansion states.

While the CDC data were collected in January through June, private survey data from the Urban Institute show further coverage gains in the third quarter of 2014, while survey data from Gallup show coverage rates holding steady over this period.

Tennessee Proposal Shows Growing Momentum for Medicaid Expansion

December 16, 2014 at 12:44 pm

Contrary to some predictions, November’s election results haven’t stalled momentum among states to adopt health reform’s Medicaid expansion.  Tennessee Governor Bill Haslam yesterday became the sixth governor — and third Republican — in the past two months to announce an expansion plan.  Twenty-seven states and Washington, D.C. have already expanded (see map).

If the federal government and Tennessee’s legislature approve it, Governor Haslam’s “Insure Tennessee” plan would extend coverage to more than 200,000 uninsured Tennesseans through a demonstration project, or “waiver.”  The federal government has approved four states’ expansion waiver proposals, which give them added flexibility over their Medicaid programs.

Insure Tennessee contains elements that the federal government has approved for other state waivers.  As in Michigan, for example, newly eligible Tennesseans with incomes above the poverty line would make monthly contributions to individual accounts to cover their premiums and cost-sharing charges.  As in New Hampshire, newly eligible Tennesseans who had an offer of coverage from their employer but couldn’t afford the premiums would get help buying it.

To date, only three southern states have expanded Medicaid, which means most of the region isn’t experiencing the positive impacts from expansion.  The Kaiser Family Foundation reported that 86 percent of Americans in the “coverage gap” — with incomes too high for Medicaid but too low for federal subsidies to buy coverage through the marketplace — live in the South.

Among the three southern states that have expanded Medicaid, Arkansas and Kentucky report the nation’s largest drops in their uninsured rates this year (10.1 and 8.5 percentage points, respectively), and West Virginia’s uninsured rate has dropped 5.7 points.

Elsewhere in the South, Virginia Governor Terry McAuliffe will include a Medicaid expansion in his forthcoming budget, North Carolina Governor Pat McCrory has softened his opposition to expansion, and a group of Florida business leaders have unveiled their own expansion proposal.  These states, along with Tennessee, could take a big step toward closing the nation’s coverage gap.

Why Re-Enrolling in Federal Marketplace Makes Sense

December 12, 2014 at 12:02 pm

As of December 5, only about 720,000 customers had returned to the federally run health insurance marketplace to re-enroll or switch plans for 2015, the New York Times reports. Our recent paper explains why people who bought private health insurance last year through the marketplace could pay more than they should next year unless they return to the marketplace to renew coverage.  Next Monday is the deadline for enrolling in coverage to start January 1.

As our paper points out:

People in 34 states who enrolled in health coverage for 2014 through the Federally Facilitated Marketplace (FFM) will be automatically re-enrolled in the same plan in 2015 unless they choose a new plan through the FFM during the open enrollment season, which began November 15 (see map).  While auto-renewal is an important backstop to avoid loss of coverage, it could leave many people paying more for health care than the Affordable Care Act envisions — and more than they will pay if they go back to the Marketplace.

Unless people provide updated information and have their eligibility re-determined, most who received subsidies for marketplace coverage in 2014 will automatically receive the same dollar level of subsidies in 2015.  (These subsidies consist of advance payments of premium tax credits, which are paid to insurers on enrollees’ behalf to help cover the enrollees’ premiums.)  But since many factors that affect the level of people’s subsidies change from year to year, a high percentage of people who auto-renew will receive advance premium credits that turn out to be too low or too high.

To avert such problems, consumers need to return to the FFM (rather than auto-renewing) to receive an updated eligibility determination.  That is the only way to ensure they receive the correct level of benefits.

 

Medicaid Expansion Isn’t Hurting State Budgets

December 9, 2014 at 10:59 am

State Medicaid spending rose just 2.7 percent in state fiscal year 2014, when health reform’s Medicaid expansion took effect in more than half of the states, a new report from the National Association of State Budget Officers (NASBO) estimates.  Along with Kaiser Family Foundation projections that state Medicaid spending in fiscal year 2015 (which began July 1 in most states) will grow more slowly in states that have expanded Medicaid than in the others, the NASBO report provides evidence that the Medicaid expansion isn’t hurting state budgets.

Both reports note a significant rise in total Medicaid spending — federal plus state — in fiscal year 2014 as 27 states plus Washington, D.C. extended eligibility to most people with incomes up to 138 percent of the poverty line.  Kaiser projects a 14 percent increase in total Medicaid spending in fiscal year 2015.

But since the federal government covers the entire cost through 2016 of covering people newly eligible for Medicaid due to the expansion (and no less than 90 percent after that), the story on state Medicaid spending is different.  Kaiser projects a 4.4 percent increase this fiscal year for Medicaid expansion states and a 6.8 percent increase for non-expansion states.

The NASBO and Kaiser reports focus on state Medicaid budgets, but Kaiser notes that expansion states will likely realize savings outside Medicaid, including in mental health, corrections, and state-funded programs for the uninsured.

As state legislative sessions approach, policymakers in a number of the 22 states that have yet to expand Medicaid are taking a fresh look.  Governors in Wyoming and Utah last week released details of their expansion plans.  These and other states considering the Medicaid expansion should note the mounting evidence that it’s no budget buster.

You can follow me on Twitter at @jcrosscall.

Six Ways Health Reform Helps the Middle Class

December 2, 2014 at 2:21 pm

Health reform offers substantial benefits to middle-class Americans, contrary to some recent claims.  Here are some of the most important ones:

  1. A safety net for all. Insurers can no longer refuse to sell someone health coverage or charge higher premiums because of a pre-existing health condition.  Health plans must now cover preventive care, such as vaccinations and routine screenings, with no cost sharing.  Plans must also limit the amount they can require enrollees to pay out-of-pocket each year for covered benefits.
  2. Financial help buying insurance. People without access to affordable coverage from an employer can receive premium tax credits to help them buy insurance in the marketplaces.  Credits are available to households with incomes up to 400 percent of the poverty level.  That’s up to $95,000 a year for a family of four.
  3. No more job lock. Because health reform helps workers without access to affordable job-based coverage afford coverage on their own, workers no longer have to stay in or choose an otherwise less desirable job simply because it offers health coverage.  They can start a business or retire early without worrying about access to health insurance.  And losing a job no longer means losing health insurance.
  4. Health coverage for young adults. Parents whose insurance provides dependent coverage may now include children up to age 26 on their plans.  As a result, more than 6 million additional young adults have enrolled in a parent’s health plan, 3 million of whom would otherwise be uninsured.
  5. Improving Medicare benefits. Health reform is gradually closing the prescription drug “donut hole,” the gap in coverage faced by beneficiaries with high drug costs.  Last year alone, 3 million seniors and persons with disabilities saved $3.9 billion on their prescriptions — more than $900 per beneficiary.  Health reform also eliminated cost-sharing charges for preventive health services (such as cancer screenings), and 37 million Medicare beneficiaries received at least one free preventive service last year.
  6. Strengthening Medicare financing. Health reform includes a number of measures to slow Medicare cost growth, such as cutting overpayments to private Medicare Advantage plans. These steps, along with other factors, have significantly strengthened Medicare’s financial outlook.  Medicare’s Hospital Insurance (HI) trust fund is now projected to remain solvent 13 years longer than before health reform’s enactment.  And the HI program’s projected 75-year shortfall has shrunk by three-quarters.