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What is the Result of States Not Expanding Medicaid?

August 29, 2014 Comments off

What is the Result of States Not Expanding Medicaid?
Source: Urban Institute

In states not expanding Medicaid, 6.7 million residents will remain uninsured in 2016 as a result. These states are foregoing $423.6 billion in federal Medicaid funds from 2013 to 2022, lessening economic activity and job growth. Their hospitals are also losing $167.8 billion in Medicaid revenue. Every comprehensive state-level fiscal analysis that we could find concluded that expansion helps state budgets, generating savings and revenues that exceed increased Medicaid costs. Future federal cuts to ACA’s high federal match rate are unlikely. Of more than 100 federal Medicaid cuts since 1980, just one lowered the federal share of Medicaid spending.

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Small Geographic Area Variations in Prescription Drug Use

August 18, 2014 Comments off

Small Geographic Area Variations in Prescription Drug Use
Source: Pediatrics

BACKGROUND: Despite the frequency of pediatric prescribing little is known about practice differences across small geographic regions and payer type (Medicaid and commercial).

OBJECTIVE: The goal of this research was to quantify variation in prescription drug use among northern New England children.

METHODS: Northern New England, all-payer administrative data (2007–2010) permitted study of prescriptions for 949 821 children ages 0 to 17 years (1.75 million person-years [PYs]; 54% Medicaid, 46% commercial). Age- and gender adjusted overall and drug group–specific prescription use was quantified according to payer type (Medicaid or commercial) and within payer type across 69 hospital service areas (HSAs). We measured prescription fills per PY (rate) and annual, mean percentage of the population with any drug group–specific fills (prevalence).

RESULTS: Overall mean annual prescriptions per PY were 3.4 (commercial) and 5.5 (Medicaid). Generally, these payer type differences were smaller than HSA-level variation within payer type. HSA-level rates of attention-deficit/hyperactivity disorder drug use (5th–95th percentile) varied twofold in Medicaid and more than twofold in commercially insured children; HSA-level antidepressant use varied more than twofold within each payer type. Antacid use varied threefold across HSAs and was highest in infants where commercial use paradoxically exceeded Medicaid. Prevalence of drug use varied as much as rates across HSAs.

CONCLUSIONS: Prescription use was higher among Medicaid-insured than commercially insured children. Regional variation generally exceeded payer type differences, especially for drugs used in situations of diagnostic and therapeutic uncertainty. Efforts should advance best pediatric prescribing discussions and shared decision-making.

CBO — Examining the Number of Competitors and the Cost of Medicare Part D: Working Paper 2014-04

August 18, 2014 Comments off

Examining the Number of Competitors and the Cost of Medicare Part D: Working Paper 2014-04
Source: Congressional Budget Office

Most beneficiaries of Medicare’s Part D prescription drug insurance choose among private drug plans to receive their coverage. This paper is the first to examine the relationship between the number of competing plan sponsors and the cost of Part D during the program’s first five years. Over the period from 2006 to 2010, regional Part D markets contained between 16 and 22 plan sponsors offering stand-alone plans. Consistent with economic theory, we find that increases in the number of plan sponsors within a market were associated with lower bids and lower overhead and profits of plans in that market. For example, among stand-alone plans that were not eligible to be assigned low-income beneficiaries, we find that each additional plan sponsor entering an 18-firm market was associated with a reduction in bids for a month of basic coverage to a beneficiary of average health of 0.4 percent—or $0.33 for a plan that bid $85—which corresponds to an elasticity of -0.071. (That result is an arithmetic average across six specifications in which estimates range from $0.20 to $0.50.) Because bids are used to directly determine government spending, we estimate that an additional plan sponsor nationwide was associated with a reduction in government spending of $7 million to $17 million each year.

CRS Insights — Medicare: Insolvency Postponed (July 29, 2014)

August 13, 2014 Comments off

CRS Insights — Medicare: Insolvency Postponed (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

On July 28, 2014, the Medicare Board of Trustees released their annual report on the current and projected financial status of the Medicare trust funds. Due to lower than expected Medicare Part A spending in 2013 (the base projection year) and lower expected future utilization of hospital inpatient services, the Trustees have postponed the expected insolvency date of the Medicare Hospital Insurance trust fund to 2030, four years later than projected in last year’s report.

New From the GAO

August 13, 2014 Comments off

New GAO Report
Source: Government Accountability Office

Medicare Program Integrity: Increased Oversight and Guidance Could Improve Effectiveness and Efficiency of Postpayment Claims Reviews. GAO-14-474, July 18.
http://www.gao.gov/products/GAO-14-474
Highlights – http://www.gao.gov/assets/670/664880.pdf

Arkansas, Kentucky Report Sharpest Drops in Uninsured Rate; Medicaid expansion, state exchanges linked to faster reduction in uninsured rate

August 13, 2014 Comments off

Arkansas, Kentucky Report Sharpest Drops in Uninsured Rate; Medicaid expansion, state exchanges linked to faster reduction in uninsured rate
Source: Gallup

Arkansas and Kentucky lead all other states in the sharpest reductions in their uninsured rate among adult residents since the healthcare law’s requirement to have insurance took effect at the beginning of the year. Delaware, Washington, and Colorado round out the top five. All 10 states that report the largest declines in uninsured rates expanded Medicaid and established a state-based marketplace exchange or state-federal partnership.

Health Reform and Changes in Health Insurance Coverage in 2014

August 13, 2014 Comments off

Health Reform and Changes in Health Insurance Coverage in 2014
Source: New England Journal of Medicine

In this analysis of nationally representative survey data from January 2012 through June 2014, we found a significant decline in the uninsured rate among nonelderly adults that coincided with the initial open-enrollment period under the ACA. These changes remained highly significant after adjustment for potential confounders such as employment, demographic characteristics, and income. As compared with the baseline trend, the uninsured rate declined by 5.2 percentage points by the second quarter of 2014, a 26% relative decline from the 2012–2013 period. Combined with 2014 Census estimates of 198 million adults 18 to 64 years of age,19 this corresponds to 10.3 million adults gaining coverage, although depending on the model and confidence intervals, our sensitivity analyses imply a wide range from 7.3 to 17.2 million adults.

The pattern of coverage gains was consistent with the effects of the ACA, with major gains for persons likely to be eligible for expanded Medicaid on the basis of their income and state of residence but smaller and nonsignificant changes for low-income adults in states without Medicaid expansion. Coverage gains were significant both in states with Medicaid expansion and in those without Medicaid expansion for persons with incomes between 139% and 400% of the federal poverty level, which is consistent with tax subsidies under the ACA for private insurance in this income range, regardless of state decisions regarding Medicaid expansion. Absolute gains were largest among young adults and Hispanics, two groups with high uninsured rates at baseline. State-level estimates of coverage gains were significantly associated with official HHS enrollment statistics, showing that each percentage point of the state population enrolling via the marketplaces was associated with a half-point decline in the uninsured rate. Nonetheless, the inherent lack of a control group precludes a causal interpretation for these findings, and other unmeasured factors may have contributed to these changes.

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