Medicaid may become platform for broader health care reform
Medicaid may become platform for broader health care reform
How many of the country's uninsured should be covered through public programs and how many through private insurance? This is a topic of much debate regarding health reform legislation, with some policy-makers arguing that Medicaid should be expanded to cover more low-income and high-need people.
"A lot of the plans that are being considered do build on the Medicaid program as a base for coverage expansions," says Robin Rudowitz, a principal policy analyst for the Kaiser Family Foundation's Commission on Medicaid and the Uninsured in Washington, DC, and former Medicaid director in the Office of Legislation at the Centers for Medicare & Medicaid Services (CMS). Ms. Rudowitz is an author of the May 2009 report, Medicaid as a Platform for Broader Health Reform: Supporting High-Need and Low-Income Populations.
Medicaid serving 60 million
Medicaid already serves 60 million people, providing affordable and comprehensive coverage for a low-income, high-need population. "And when you look at who is uninsured, two-thirds are low-income, and many do have significant health needs," says Ms. Rudowitz.
She notes that two leading proposals involve expanding Medicaid for all adults up to 115% and 150% of the FPL. Some states already have used Medicaid as a base for expanding coverage to childless adults who are not currently eligible for Medicaid.
"Many states have been taking action to try to address the uninsured population, but that has been somewhat halted by what is happening with the recession and also potentially because of the discussions on federal health care reform," says Ms. Rudowitz. "Certainly, states are struggling right now, in an extremely challenging fiscal environment. The recession has led to a major decline in revenue at the same time as there are major caseload increases and more uninsured. So, states have immediate concerns on their budget side."
Another consideration is the varying impact that federal floors in terms of eligibility levels will have across the states. "Individual states are concerned about the floors and how the financing would be divided between the federal government and the states," says Ms. Rudowitz. "And those concerns are particularly heightened due to the recession. There is variation in their experience with the recession, but all states are feeling the impact."
Improvements are possible
Nationally, a lot of attention is being paid to the reforms made in Massachusetts, which are built heavily on the Medicaid program. However, Ms. Rudowitz notes that Massachusetts was "in a different starting place" than many states, because its health reform efforts already had expanded Medicaid.
Overall, Medicaid is considered to be a low-cost program, especially when compared to the cost of private insurance. "There is lots of research that shows that Medicaid provides access comparable to private insurance, especially for primary preventive health," says Ms. Rudowitz.
Medicaid has public support
Medicaid also has broad public support, and the public clearly favors using Medicaid as an option to expand coverage. In a 2007 Kaiser survey on children's health coverage for low-income families, 95% of respondents said they thought Medicaid and CHIP were good programs, and over 90% of parents said they would enroll their children in CHIP. "What we are hearing in some focus groups is that because of the recession, individuals who have never needed public assistance are losing coverage and coming to seek assistance for the first time through Medicaid," adds Ms. Rudowitz.
However, there are few options for single adults. "For children, there has been a pretty good safety net. But the recession has heightened the awareness of the gap in safety coverage," says Ms. Rudowitz. "There are certainly ways to strengthen Medicaid to make it a stronger platform, such as making eligibility based on income and eliminating categorical requirements. And while there has been a lot done to simplify the application process, there is more that can be done."
Providers cite admin burdens
When providers are asked why they are not participating in Medicaid, they typically cite low reimbursement and administrative burdens. "These can potentially be addressed, although of course, on the provider side there are larger issues," says Ms. Rudowitz. "With dental care in particular, there are access issues that go far beyond Medicaid because of the lack of providers."
Another possibility is the chance to reform Medicaid's payment policy. "If an expansion of Medicaid occurs, it would be an opportunity to look at the split and the share of the financing between states and the federal government," says Ms. Rudowitz.
Contact Ms. Rudowitz at (202) 347-5270 or [email protected].
How many of the country's uninsured should be covered through public programs and how many through private insurance? This is a topic of much debate regarding health reform legislation, with some policy-makers arguing that Medicaid should be expanded to cover more low-income and high-need people.Subscribe Now for Access
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