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Daily Archives: April 18, 2016

Study: Medicaid Expansion Encourages More Poor Adults To Seek Health Care

In states that expanded Medicaid under the Affordable Care Act, low-income adults were more likely to see a doctor, stay overnight in a hospital and receive their first diagnoses of diabetes and high cholesterol, according to a study published Monday.

Yet researchers found no improvement in adults’ own assessments of their health, a conclusion echoed by similar studies, the authors wrote in the Annals of Internal Medicine.

Two factors might explain the lack of perceived improvement. People did not sign up for Medicaid as soon as it expanded in January 2014 so there was little time to better their health. Also, survey participants’ increased contact with health providers and fresh knowledge about their health might have negatively affected their opinions, the authors said.

Medicaid Expansion - March 14, 2016
Researchers at University of Michigan and the University of California-Los Angeles who did the study said it provides the first evidence of low-income adults’ increased use of health services in states that expanded Medicaid. Federal surveys of adults living in poverty conducted in the second half of 20Ǯ were the foundation for the study. Twenty-six states and District of Columbia expanded Medicaid in 2014 and five more have since then.

Medicaid enrollment has soared past 70 million people since states began expanding the program in 2014 using federal dollars from the law. Medicaid rolls have grown by more than 14 million people in that time.

This KHN story also ran on CNN.com. It can be republished for free (details).

Opponents of expansion have cited many reasons why states should not expand the program including fiscal concerns and doubts about Medicaid’s effectiveness in in improving health to the poor.

Joel Cantor, director of the Rutgers University Center for State Health Policy, said the study confirms that enrolling people in Medicaid means they are more likely to access health services. He anticipates better results in 2015 after people have more time to use their healthcare coverage. “Health status is not a leading indicator. It’s a lagging indicator,” said Cantor, who was not involved in the study.

“The first step is people get coverage. Second, they get care,” he said. The third step is better health and we will see that in later years.”

The study’s authors also said low-income adults’ greater use of health services could pay dividends in the future.

“The increased detection of chronic health conditions under the Medicaid expansions could have important implications for both population health and national health care spending if it leads to improved management and control of these conditions,” noted the study.

Among the study’s findings:

  • The share of respondents who said they saw or talked to a doctor increased from 58 percent before expansion to nearly 68 percent after expansion. There was virtually no change in states that did not expand.
  • Those who said they were diagnosed with diabetes rose from 8.3 percent before expansion to nearly 13 percent after expansion. In non–expansion states, the diabetes diagnosis dropped slightly.
  • Those who said they had no usual source of care due to costs fell from 13.3 percent pre-expansion to 6.6 percent after expansion. This number dropped only marginally in non-expansion states.

Before the Affordable Care Act’s passage in 2010, a concern was whether the health care workforce was large enough to handle increased demand from a larger insured population, said Vernon Smith, a Medicaid expert and principal with consulting firm Health Management Associates.

“The study shows that the health care system has accommodated the increased demand and access improved for those who were newly insured,” he said.

“The results provide compelling evidence that states that expanded Medicaid did a very, very good thing for their citizens, because those who got coverage are now more likely to get medically necessary care when they need it,” Smith added.

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Competition Suffers Most If UnitedHealth Exits Obamacare In 2017: Analysis

If United Healthcare follows through on its threat to quit the health insurance marketplaces in 2017, more than 1 million consumers would be left with a single health plan option, forecasted an analysis released Monday.

A UnitedHealthcare pullout would be felt most in several states, generally in the South and Midwest, where consumers would be left with little choice of plans, the Kaiser Family Foundation reported. (KHN is an editorially independent program of the foundation.)

In most of the 34 states where United operates this year, though, the effect would be modest for premiums and the number of plan options, Kaiser said.

Kaiser’s analysis was made public a day before UnitedHealth Group, the insurer’s parent, is expected to announce 2017 plans for the Affordable Care Act’s marketplaces that provide coverage to individuals who shop for their own health insurance.

In the past week, state officials confirmed UnitedHealth was withdrawing from marketplaces in Arkansas and Michigan and partially leaving Georgia. In Atlanta and Chicago, a new UnitedHealthcare subsidiary, Harken Health, began operating this year and is expected to remain.

Last year, UnitedHealthcare said it was losing hundreds of millions of dollars on the Obamacare plans and would decide its future participation by mid-2016. Health plans need to begin notifying states by May whether they plan to sell in marketplaces next year.

More than one in four counties where UnitedHealthcare participates nationally would see a drop from two insurers to one if the company exits and isn’t replaced by a new entrant, and a similar number would go from having three insurers to two, the Kaiser analysis found.

In total, 1.8 million enrollees would go from having a choice of three insurers to two, and another 1.1 million would go from having a choice of two insurers to one, the report said.

A UnitedHealth withdrawal would leave marketplace enrollees in Kansas and Oklahoma with only one insurer if another company does not move in, Kaiser said.

Its analysis cited the potential impact in other states if UnitedHealthcare drops out:

  • In Alabama, about two-thirds of enrollees — those living in 60 counties — would go from having a choice of two insurers to a single insurer, and the remaining 33 percent of enrollees in seven counties would have two insurers to pick from.
  • In Mississippi, 43 percent of enrollees  in 50 counties would drop to just a single insurer and the remaining 57 percent in 32 counties would still have two.
  • In Arkansas, there would be a drop from four insurers to three insurers in every county if a new insurer did not replace the company.
  • In Georgia, nearly 50,000 marketplace enrollees, or 8 percent of the total, would be left with a choice of two insurers. Another 20,000 enrollees, or 3 percent, would have only one insurer if no new entrants replaced UnitedHealthcare.

Nationally UnitedHealthcare’s participation on the exchanges had a relatively small effect on average premiums, based on Kaiser’s analysis of 2016 insurer premiums.

The company was less likely to offer one of the lowest-cost silver plans, where most enrollees sign up. When it did offer a low-cost option, its pricing was often close to its competitors. As a result, the weighted average premium for a benchmark silver-level plan would have been about 1 percent higher had United not participated in 2016. Federal subsidies in the marketplaces are based on the second-lowest silver premium.

Benjamin Wakana, a spokesman for the Centers for Medicare & Medicaid Services, said the government expects insurers to make adjustments in entering and exiting states.

“The marketplace should be judged by the choices it offers consumers, not the decisions of any one issuer. That data shows that the future of the marketplace remains strong.”

UnitedHealth Group will release its first-quarter earnings Tuesday morning and CEO Stephen Hemsley is scheduled to discuss the results with analysts and investors at 8:45 a.m. ET.

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Viewpoints: Local Government Speanding And Life Expectancy; Making Childhood Cancers A Moonshot Target

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State Highlights: Questions Surround Future Of Kansas Mental Hospital; Documents Reveal Gaps In Wisconsin’s Reporting Of Elizabethkingia Outbreak

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Conn. Dentists Say Plan To Cut Medicaid Reimbursements Threatens Access For Patients

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Activists, Lawmakers Steer Anti-Abortion Conversation Toward Perinatal Hospice Care

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Customer Refunds Give Pa. Hospital Skin In The Game

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How The Mental Health System Failed Family Of Woman With Schizophrenia

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Once Seen As Enabling Drug Use, Bronx Needle Exchange Now Embraced As Public Health Strategy

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Pharmaceutical Company Warner Chilcott To Pay $125M In Health Care Fraud Case

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