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Daily Archives: January 21, 2015

Medicaid Pay Hike Opens Doors For Patients, Study Finds

Money talks.

A temporary Medicaid pay raise that was part of President Barack Obama’s health law made it easier for poor adults to get appointments with primary care doctors, according to a study published Wednesday.

Paying more to doctors who participate in the federal-state insurance program for the poor usually improves access for patients, but the law’s two-year limit on the raise, its slow rollout and other regulatory problems made many skeptical about how, if at all, physicians would react to the extra money — which in many states equated to a 50 percent pay hike or more.

doctor money 570The federally funded pay raise started in 2013 and ended Dec. 31, though a few states have continued the higher rates using their own money. The money was included in the health law to ensure there would be enough doctors to handle the surge of people who gained Medicaid coverage starting in 2014. Under the law, Medicaid would pay the same rates to family physicians, pediatricians and internists as Medicare, the federal health program for the elderly and disabled. The higher reimbursement was available whether or not states expanded Medicaid.

The 10-state study, published in the New England Journal of Medicine, found the availability of primary care appointments for Medicaid patients rose by nearly 8 percentage points after the raise was enacted, compared to only about a 1 percentage point increase among privately insured patients who were used as a basis for comparison.

States where doctors had the biggest pay raises — New Jersey, Pennsylvania, Illinois and Texas — all increased appointment availability by at least 10 percentage points. In each of those states, doctors received at least a 66 percent pay hike, the study said. The other states in the study were Georgia, Arkansas, Massachusetts, Oregon, Iowa and Montana.

This KHN story can be republished for free (details).

“The two-year fee increase in Medicaid appears to have led primary care providers to make more appointments available for new Medicaid patients, at least in these 10 states,” said Genevieve Kenney, a senior fellow at the Urban Institute who worked on the report with University of Pennsylvania researchers.

The study did not examine whether the pay raise led more doctors to participate in the federal-state insurance program who were previously not seeing Medicaid patients. Most state Medicaid officials have said they did not see such a surge of new doctors.

The study was done by having staff posing as patients call primary care physicians’ offices and ask for new patient appointments. The calls were initially made in November 2012 through March 2013, before the pay raise was implemented in most states. A second round of calls was made from May 2014 through July 2014.

Medicaid enrollment has soared by nearly 10 million people in the past year as 27 states expanded eligibility for the program under the law. Even in states that did not expand, Medicaid enrollment has jumped due to publicity about the Affordable Care Act and its new online marketplace.

The big question is whether doctors who saw more Medicaid patients when they were paid more will limit their number since the program expired.

Tom Banning, CEO of the Texas Academy of Family Physicians, said he believes that is happening. “Unfortunately, we are hearing from doctors that have had stop seeing Medicaid patients because they can’t take the financial hit.”

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Arkansas Medicaid Plan Offers Mixed Lessons

The double-sided city of Texarkana, its residents sometimes quip, has two of everything. There are the mayors: one for the 36,000 people living west of Highway 71 in Texas, another for the 30,000 on the Arkansas side of town. There are the high schools: Texas High and Arkansas High, bitter football rivals.

And then there are the approaches to helping poor people get medical care. In Arkansas, lawmakers voted in 2013 to expand the state’s Medicaid program, taking federal money to buy private insurance for low-income adults. Texas, by contrast, has steadfastly refused to expand its Medicaid program.

So in Texarkana, access to free health care can be determined by the side of the street on which someone lives.

Shortly after Arkansas launched its “private option” plan expanding coverage for the poor, advocates for the uninsured began pushing Texas lawmakers to follow the lead and devise a “Texas way” to expand coverage. But in its first year, the Arkansas plan is costing more than expected, and a growing chorus of Texas Republicans is saying “I told you so.”

Backed by the influential Texas Public Policy Foundation, a conservative think tank, they now cite the neighboring state’s experience as a cautionary tale against Medicaid expansion in any form. Three other states also have received federal permission to try alternative forms of coverage expansion.

“What I’m seeing in a lot of those states is the illusion of flexibility,” said state Sen. Charles Schwertner, a Republican and chairman of the upper chamber’s Health and Human Services Committee. “You’re aware that Arkansas is over budget?”

Arkansas has enrolled about 213,000 people in its program, dropping the state’s share of uninsured roughly 10 percentage points between 2013 and 2014, according to state records. In Texas, by comparison, about 1 million people would be eligible for health coverage under an expansion.

This copyrighted story comes from The Texas Tribune, produced in partnership with KHN. (Learn more about republishing Texas Tribune content)logo texas tribune

But in its first nine months, Arkansas spent $9.3 million more than it said it would, according to the state’s Department of Human Services. State officials say they have made changes to reel in costs.

Those who want to see Texas expand its coverage, meanwhile, say the foibles in Arkansas aren’t applicable in Texas, which can always craft a better plan of its own.

“The first thing I’d say is, we’re not Arkansas,” said John Hawkins, a senior vice president of advocacy for the Texas Hospital Association, which favors a private-market coverage expansion. “Why would we give our leverage away, why would we even reject negotiating out of hand, when we don’t know what the possibilities are?”

It is a tale of two vastly different approaches to federal health care reform. The Lone Star State, under the leadership of outgoing Gov. Rick Perry, has adamantly opposed all aspects of “Obamacare,” including an optional expansion of Medicaid financed mostly with federal money. Arkansas, on the other hand, was the country’s first to pioneer a “private option,” passed by the state’s Republican-controlled legislature in 2013, using federal money to buy private insurance for residents below 138 percent of the poverty line.

When Arkansas lawmakers negotiated the three-year plan, they agreed to spend no more than $477.63 per person each month in 2014. But at the end of the year, the actual per-person-per-month cost was $489.85, according to the state.

If Arkansas still exceeds the spending cap after three years, the state will be on the hook for the extra cost, but state officials say they are not concerned.

“There’s a caveat,” department spokeswoman Amy Webb said. “We have not yet reconciled with the insurance carriers related to cost-sharing reduction or medical necessity. At the end of our three-year waiver, we feel like we will be within the limit.”

That has not stopped the critics. John Davidson, a health policy analyst at the Texas Public Policy Foundation, said Texas cannot afford the risk of cost overruns jeopardizing other priorities, like education.

“When you put a population that’s eligible for Medicaid into private coverage like Arkansas did, you’re going to end up paying more because you’re paying premiums on a private plan, and those are just more expensive,” he said. “At the very least, they’re nondisabled people who are working age, so the idea for a lot of conservatives is that for folks who are able-bodied and working age, what they really need is a full-time job, not Medicaid expansion.”

The future of Arkansas’ program is itself unclear. After sweeping Republican victories at the polls in November, state lawmakers there are threatening to repeal the expansion altogether. Newly elected Republican Gov. Asa Hutchinson has said he will give a speech on the future of the program next week.

Twenty-seven states and the District of Columbia have expanded Medicaid, and seven others are considering it, according to the Kaiser Family Foundation. Arkansas would be the first state to drop out of an expansion.

In Texas, Medicaid covers 3.7 million poor, disabled and elderly people, including children, and costs roughly $40 billion per year, of which the federal government pays about 60 percent. Under the Affordable Care Act, the federal government offered to cover all of Texas’ Medicaid expansion costs for three years, eventually reducing its contribution to 90 percent.

Republican lawmakers considered an alternative “Texas solution” to Medicaid expansion during the 2013 legislative session that would have drastically reformed the program. That proposal, led by state Rep. John Zerwas, R-Richmond, failed. The Legislature ultimately approved a requirement that the Health and Human Services Commission receive legislative approval before expanding Medicaid eligibility.

Texas’ Legislature has only moved further to the right since then. Whether Zerwas will stick his neck out again this year remains to be seen, he said.

“There needs to be kind of a sense from the highest levels of leadership whether there’s interest and support for that,” he said. “I don’t have any sense of where the new governor’s office is on this, where the lieutenant governor is on this, or the speaker, for that matter.”

Gov.-elect Greg Abbott, who campaigned fiercely against Obamacare as federal overreach, has not publicly appeared receptive to Medicaid expansion. “Fear not — Governor-elect Abbott has fought Obamacare and will continue to fight against it,” Abbott spokeswoman Amelia Chassé recently told the conservative National Review.

But he has not categorically ruled out an alternative form of expansion, either. This week, in an interview with The Wall Street Journal, he gave advocates for such a program a sliver of hope.

Though he is against the expansion of Medicaid as it exists, Abbott said, “like anyone with an inquiring mind, we’ll look at any idea anyone has.”

Disclosure: The Texas Public Policy Foundation is a corporate sponsor of The Texas Tribune. A complete list of Tribune donors and sponsors can be viewed here.

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Next Goal For Abortion-Rights Backers: Reducing Stigma

Deb Hauser was a married mother of a 6-month-old when her husband “went to work one day and didn’t come home.” Two weeks later, she realized she was pregnant.

“I’m working full time. I’ve got this 6-month-old, and all of a sudden I’m pregnant,” she remembers. “I didn’t have any idea what was going to happen. I didn’t know if he was going to come back; if my marriage was going to stick. I didn’t know where I was going to get the money I needed. All I know is I had a responsibility to my 6-month-old.”

Hauser had an abortion, “which was absolutely the right thing to do for me, and for my son,” she says. “I never ever regretted it.” Eventually her husband was diagnosed with bipolar disorder, they were divorced, and she remarried and raised her son, who is now 20. “Abortion has played a really important role in my life,” she said. “It got me stable again.”

Pro-choice activists hold signs as marchers of the annual March for Life arrive in front of the U.S. Supreme Court January 22, 2014 on Capitol Hill in Washington. (Photo by Alex Wong/Getty Images)

Pro-choice activists hold signs as marchers of the annual March for Life arrive in front of the U.S. Supreme Court January 22, 2014 on Capitol Hill in Washington. (Photo by Alex Wong/Getty Images)

Now she wants to help other women tell their abortion stories. It’s part of an effort by her organization, Advocates for Youth, and several others to “de-stigmatize” abortion. As the 42nd anniversary of the Roe v Wade decision that legalized abortion approaches Thursday, abortion rights forces hope this new tack will help them reverse the momentum gained by abortion opponent in recent years. Not only have states passed a growing list of abortion restrictions, but with the U.S. Congress now in GOP hands, federal restrictions are likely to pass as well.

“It’s very clear that pro-life legislators and people running for office are on the offense now,” said Marjorie Dannenfelser, president of the anti-abortion advocacy group, the Susan B. Anthony List. “It’s also very clear that our opponents are on the defense.”

Planned Parenthood President Cecile Richards, who appeared at the National Press Club in Washington a day before Dannenfelser, conceded as much.

This KHN story also ran in The Daily Beast. It can be republished for free (details). logo daily beast 18

“The new Congress is introducing anti-women’s health bills at the rate of one per day,” she said. The House is expected to vote on a bill to ban abortions after 20 weeks of pregnancy on the day of the Roe v Wade anniversary.

But in addition to fighting legislative efforts, abortion rights backers hope to change the public view of abortion, much as gays and lesbians have done of homosexuality in recent years.

Having more women talk about their experiences, they say, will help underscore the statistic that an estimated one in every three American women will have an abortion during their reproductive lifetime.

“Probably everybody knows somebody who’s had an abortion,” said Lindsay Rodriguez of the National Network of Abortion Funds. “They just don’t know they know somebody who’s had an abortion.”

The stigma around abortion “permeates every aspect of our culture,” says Steph Herold of the Sea Change Program, another group working to make it easier to talk not just about abortion but about other “stigmatized reproductive experiences,” including infertility and miscarriage.

Herold says the stigma is everywhere, from media depictions “where a person who’s had an abortion is often stereotyped as selfish or immoral” to hospitals, which may refuse to provide the procedure not because of ideology, “but because they’re afraid of the backlash or anti-abortion protesters.” Herold says stigma even prevents women from talking about abortion with people they’re close to “for fear it might ruin their reputation or their friendships.”

Advocates for Youth has launched the 1 in 3 Campaign, which has so far collected some 700 abortion stories in audio, video, and print versions. Last fall, the project hosted an eight-hour online “speak out,” at which more than 100 women shared their stories. It’s also prompted a book and a play, Out of Silence, debuting this week in Washington D.C., based on some of the stories.

The goal is two-pronged — to give women a safe place to talk about their experiences and to boost support for abortion rights, says Hauser. “We know from the research that the No. 1 predictor of whether or not you say you’re pro-choice and vote pro-choice is if you know someone who’s had an abortion,” she says.

Richards says the movement to de-stigmatize abortion also has a special appeal to younger women. “They are much more open about sex, sexuality, sexual identity, and abortion,” she said.

Planned Parenthood consulted on the production of last year’s indie film “Obvious Child,” in which a young comedian played by Jenny Slate finds herself unexpectedly pregnant after a one-night stand. “It was so refreshing,” Richards said. “Most of the time abortion is talked about [in the media] it’s some gothic story. This was really about a young woman’s life. What happened, what she decided to do with the support of her family, even her boyfriend.”

Advocates of women “coming out” with their abortion stories are quick to admit that they’re following a page from the same-sex marriage playbook.

“More and more people in the U.S. became aware of the people in their lives who they knew who were gay,” said Jessica Arons of the Reproductive Health Technologies Project. “And they started to become more comfortable with it.” Even abortion opponent Marjorie Dannenfelser says the effort is good politics. “In terms of tactics, it’s smart. I have never underestimated their ability to do the smart thing,” she said.

Which is not to say she agrees that speaking out will – or should – eliminate the stigma. “It’s very true that women are afraid to talk about their abortion,” she says. “It’s very true that there is a lot of shame associated with it. The question is what are the root causes of those things? If this is a child, it’s complicated in a different way.”

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Viewpoints: Defending The Health Law; ‘Bring Back The Asylum'; Growing Maternity Expenses

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State Highlights: Calif. Pharmacists Broaden Scope Of Practice; Mo. Bill Would Expand Medicaid For Vets

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Need A New Knee? That’ll Be $11K — Or $70K, Depending On Where You Live

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Higher Premiums, Controlled Medical Costs Drive UnitedHealth Profit Up

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House Republicans Plan Vote On Abortion Bill Despite Complaints From Women Lawmakers

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High Court Hears Arguments In Bid To Force Higher Medicaid Payments

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Wyoming Medicaid Expansion Debate Continues

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