Spike in ER, Hospitalization Use Short-Lived After Medicaid Expansion

(Getty Images)

(Getty Images)

While the Medicaid expansion may lead to a dramatic rise in emergency room use and hospitalizations for many of the previously uninsured, that increase is largely temporary and should not lead to a dramatic impact on state budgets, according to a new analysis from the UCLA Center for Health Policy Research released Wednesday.

Researchers reviewed two years of claims data from nearly 200,000 Californians who had enrolled in public programs in advance of the expansion of Medi-Cal, the state’s version of Medicaid, in January. These programs were designed to ease the expansion of Medicaid by providing insurance to low-income adults who were not eligible for Medi-Cal at that point but would be when the health law’s expansion went into effect earlier this year.

Researchers then divided the group into four categories, based on the researchers’ assessment of each group’s pent-up demand for health care.

In July, 2011, after being enrolled in California’s Low Income Health Program, the so-called “bridge to reform,” the group with the highest pent-up demand had a rate of costly emergency room visits triple — or more — that of the other groups. But from 2011 to 2013, that high rate dropped by more than two-thirds and has remained “relatively constant,” according to the analysis. Continue reading

Long-Fought Medi-Cal Provider Rate Cuts Take Effect

Health care providers joined in a rally at the state capitol to protest cuts in Medi-Cal reimbursement rates in June, 2013. (California Medical Association/Flickr)

Health care providers joined in a rally at the state capitol to protest cuts in Medi-Cal reimbursement rates in June, 2013. (California Medical Association/Flickr)

A long-awaited and much-feared ten percent rate cut goes into effect Thursday for doctors and clinics reimbursed through Medi-Cal –- the state’s health insurance for low-income patients. This comes at the same time the federal health overhaul is expanding that program to as many as 2 million Californians.

Provisions of the Affordable Care Act will protect primary care doctors from the cuts for the next two years, but specialty doctors that treat the poor are bracing for the hit. Many physicians in dermatology, neurology, cardiology, and urology will now be losing money on every Medi-Cal patient they see. Some will have no choice but to turn low-income patients away.

“Bottom line, they cannot continue to provide care for below the cost of care,” says Shannon Smith-Crowley, a lobbyist who works closely with the California Medical Association. Continue reading

Medi-Cal Enrollment Surging Via Covered California

(David McNew/Getty Images)

(David McNew/Getty Images)

David Gorn, California Healthline

The Department of Health Care Services released enrollment numbers last week for Medi-Cal-eligible Californians who initially contacted the Covered California health benefit exchange.

The department said 143,608 people will likely receive Medi-Cal coverage as a result of contacting Covered California.

That’s about 40 percent of all applications completed through the exchange, said Anthony Cava, a spokesperson for DHCS.

“We are very pleased with this surge of interest and the momentum we are seeing in consumer awareness,” Cava said in a written statement. Continue reading

For This Uninsured Man, Medicaid Looks Good

Brad Stevens used to think he didn’t need health insurance. (Sarah Varney/Kaiser Health News)

Brad Stevens used to think he didn’t need health insurance. (Sarah Varney/Kaiser Health News)

By Sarah Varney, for Kaiser Health News and NPR

Have you heard about the young invincibles? That’s the name given to young people who think nothing bad can happen to them.

Enrollment of healthy people like them in insurance under the Affordable Care Act is key to offsetting the costs of older, less healthy buyers.

Brad Stevens is 54-years-old and not so invincible anymore. He has been uninsured for most of his adult life — “ever since about 24 when I finished college,” he says. “Basically, I’ve always tried to take care of myself and be healthy and exercise and eat right and take vitamins and that type of thing.”

During the three decades Stevens has spent without health coverage, there have been numerous attempts to curb the ranks of the uninsured in the U.S. Now, the Affordable Care Act is changing the nation’s insurance market.

Stevens, who lives in Lakeport, on the west shore of northern California’s Clear Lake, has plenty of company. Twenty percent of California’s population is uninsured; some 5 million people could gain coverage under the health law.

The Kaiser Family Foundation surveyed 2,000 of California’s uninsured on the eve of the opening of health care exchanges across the country. Stevens took part in the survey, which aims to follow the same people over the next two years. (Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.)

Over the years, Stevens wasn’t interested in the debate over how best to provide health care to the uninsured. He didn’t view it as an issue for him. “I’m the epitome of health, and so I didn’t have much concern. My health care was working out every day, eating right and taking care of myself,” he says. Continue reading

Low-income California Children Among Least Likely to Get Dental Care

Almost 60% of California children on Medi-Cal did not receive any dental care in 2011 (nmoira/flickr)

Almost 60 percent of California children on Medi-Cal did not receive any dental care in 2011. (nmoira/flickr)

Young people who don’t get the routine dental care they need find themselves at a disadvantage, studies have shown: not just in overall health but also in school performance.

Now a study from the Pew Charitable Trusts finds that California is among the 10 states where low-income children are least likely to receive dental care.

Almost 60 percent of children with Medi-Cal did not receive any dental care in 2011, said co-author Jane Koppelman.

“What it means is that kids can have insurance, they can have (Medi-Cal), but it’s more like a hunting license than an entitlement,” says Koppelman, research director for the Pew Children’s Dental Campaign. “It’s a license to try to find a dentist who can give you care. And in a lot of areas that is quite a trial.”

Continue reading

Oregonian Describes Life — and Health — After Winning Medicaid Lottery



For you wonks out there, Kaiser Health News has a fascinating Friday afternoon read for you.

In a piece titled “Bloggers See Own Reflections in Oregon Medicaid Study,” reporter Jordan Rau describes how this week’s news about Oregon’s Medicaid Experiment quickly became “a Rorschach test for how partisans and health policy wonks view the health care law.”

With no money for better food, no money for good shoes to go on walks, no rain gear, no walkman for listening to music as a distraction while walking, change is harder.

To quickly recap, in a New England Journal of Medicine study researchers analyzed how 10,000 people who won Medicaid coverage have fared since they gained insurance. The highlights were: no apparent affect on physical health; rates of depression 30 percent lower than those without coverage; catastrophic out-of-pocket medical expenses essentially eliminated.

In his piece, Rau publishes excerpts from seven blogs, each with a different take on the study’s highly nuanced results. But he closes with something I hadn’t seen elsewhere: a view of the experiment by someone who says he was one of the winners of the Medicaid coverage. Rau found the post on the blog Robert’s Stochastic thoughts.

Here’s the post in its entirety:

I am one of the winners in the Oregon lottery [winners could get Medicaid]. Going from no insurance to insurance is very confusing. When you have no money every health question starts with “would I rather live with this problem and have electricity, or treat this problem and keep my milk in a cooler for a month or so?” Stepping back into healthcare was like Continue reading

Feds to States on Medicaid: Expand Fully or No New Funding

HHS Secretary Kathleen Sebelius, shown here speaking at a conference in Washington last week. (Chip Somodevilla/Getty Images)

HHS Secretary Kathleen Sebelius, shown here speaking at a conference in Washington last week. (Chip Somodevilla/Getty Images)

The Obama Administration handed down a key rule Monday on its health care overhaul having to do with Medicaid, or Medi-Cal in California. States must expand to the federally mandated 138 percent of poverty in order to receive matching funds for those newly eligible for the program.

Because the Supreme Court ruling in June had struck down the requirement that states participate or lose existing match funds, some states thought there might be flexibility in the expansion. But the answer to that question is a clear “no” as Secretary of Health and Human Services Kathleen Sebelius explained in a letter to governors.

In a briefing last week, California’s Health and Human Services Secretary Diana Dooley indicated she was waiting for guidance from the feds about the Medicaid expansion and might not expand to the full 138 percent limit.

In an email, a spokesperson for the state’s department of health and human services said staff is currently evaluating the new information and declined to comment further at this time.

Consumer advocates said it was good to have the matter settled. “We thought that it was the case,” Anthony Wright, Executive Director of Health Access told me in a phone call, “but it’s good for the federal government to provide clarity and hopefully this allows the states to move forward with all deliberate speed.”

It’s expected that more than four million Californians will be newly eligible for Medi-Cal. Under the Affordable Care Act, the federal government will pay 100 percent of the cost of those new eligibles from 2014 to 2017. After that, the match will phase down to 90 percent by 2020.

Fiscal Cliffnotes: 6 Health Care Questions, Answered

By Mary Agnes Carey, Kaiser Health News

(Graphic: Kaiser Health News)

(Graphic: Kaiser Health News)

The so-called “fiscal cliff” is a package of automatic spending cuts and tax hikes set to kick in next month unless President Obama and Capitol Hill agree on a way to stop them.

Negotiations to avert the cuts are ongoing and both sides have exchanged offers. On one side, the president and congressional Democrats have said they will reduce spending on entitlements, including Medicare, if Republicans will agree to increase tax rates on the highest earners.

And on the other side, Republicans have agreed to more revenue — but by closing loopholes and eliminating some deductions. They oppose raising tax rates.

Here are answers to six questions about what could happen in health care before the end-of-year deadline.

Q: If no deal is struck, how would that affect Medicare patients as well as the hospitals and physicians and other providers who care for them? Continue reading

Health Care Stakes are High in California

By Sarah Varney, Kaiser Health News

President Obama's health care overhaul largely survived court challenges, but the presidential election poses another hurdle for its fate. (Mark Wilson: Getty)

President Obama's health care overhaul largely survived court challenges. The presidential election poses another hurdle. (Mark Wilson: Getty)

If Caroline Cunningham wakes up in her Studio City home on Wednesday morning to a President-elect Mitt Romney, she knows the first thing she will do. “I have to rush and get back surgery,” she says.

Cunningham, a 62-year-old mental health therapist with spinal stenosis, has health insurance coverage through a temporary program established for people with pre-existing conditions under the Affordable Care Act. The pre-existing condition insurance plans, mandated in every state and subsidized by the federal government, offer coverage to those deemed uninsurable.

But the high risk pools, as they are known, have an expiration date. They are slated to shut down in January 2014 when, under the federal health law, people with pre-existing conditions can buy plans from private insurers through newly created insurance exchanges.

If Romney follows through with his pledge to dismantle President Barack Obama’s signature domestic legislation and Congress is unable to quickly enact a meaningful alternative, Cunningham worries she will, once again, be uninsured. “I called the Romney campaign and asked them what they’re going to do,” said Cunningham. “I hope they wouldn’t dump us.”

Medicaid Expansion

More than any other state, California has wagered heavily on the Affordable Care Act. It has moved quickly to erect an insurance exchange and establish the high risk pool. It has also put federal consumer protections into state law. Continue reading

No Matter Who Wins, We’re Still Heading for A Cliff

By Julie Rovner, Kaiser Health News

(Su-Lin: Flickr)

(Su-Lin: Flickr)

Whatever the outcome on November 6th, officials in Washington will still have to deal with a looming “fiscal cliff” before the end of the year.

What’s coming is a perfect storm of expiring tax cuts, scheduled budget cuts, and various other spending changes scheduled to take place Jan. 1 unless Congress and President Obama (who, no matter what, will still be president until next Jan. 20) agree on a way to avert them.

As two of the largest spending items in the federal budget, the Medicare and Medicaid health programs are expected to play a role in how the deal gets done. Under the provisions of the law that created the budget deal Congress will attempt to undo, Medicare is subject to a two percent cut in provider payments, while Medicaid is exempt.

But two new studies and a proposed class action lawsuit settlement suggest a lot of dollar signs could change as lawmakers start to think about how to address the impending mess. Continue reading