Thursday, May 02, 2013

Obamacare Medicaid Expansion

Georgia, like many southern states, has rejected the Obamacare Medicaid expansion and with good reason. We can't afford it.

Obamacare Medicaid expansion
Critics say this hurts the poor (no real argument there) but there is only so much taxpayer dollars to spread around and we can't fund everything for everyone.

Money Doesn't Grow on Trees

The folks in DC say "No problem. We have a printing press. How much do you need?".

Informed citizens know this is a joke, and a bad one at that. Eventually all those borrowed funds will need to be repaid and the party is over. Problem is, we are the ones that have to pick up the empty beer bottles and empty the ashtrays after Washington has partied on OUR money.

Half the states have either rejected Obamacare Medicaid expansion or are undecided.

Problem with that is, Obamacare is counting heavily on Medicaid expansion to cover 15 - 20 million who may currently be uninsured.

Even though DC has offered to fund the expansion, it is only for a few years.

PCIP Failure

Of course they also gave us PCIP to cover folks with pre-existing conditions and the program worked reasonably well until it ran out of money and the had to close the program for new applicants 9 months before 2014 when carriers are required to issue a policy to anyone, regardless of health.

Arkansas Private Medicaid Option

So now Arkansas, a red state for sure, has extended an olive branch to DC by suggesting a private Medicaid option.

The Arkansas plan would allow Medicaid beneficiaries to use the newly created Obamacare health insurance exchanges to purchase a plan of their choice using (our) federal tax dollars.

This is a stroke of genius because it put's the monkey on the back of the folks in DC that created this mess and keeps the state funds out of it.

But it is not without issues.
Commercial insurers' doctor networks are generally wider than Medicaid networks. Entrée for Medicaid patients could improve access to care and prevent minor illnesses from spiraling into expensive hospitalizations.
It could also reduce care disruptions for those whose incomes fluctuate, shifting them between Medicaid and the subsidized exchanges.
At the same time, adding thousands of Medicaid members to the exchanges could reduce the risk that a few chronically ill patients would sharply drive up exchange premiums
All this sounds good in theory, but the truth is, most carriers have  opted out of the federal health insurance exchanges. The ones that will play will offer NARROW provider networks and SKINNY drug formulary coverage.

Private insurance plans offered on the exchange will look more like HMO plans than the traditional PPO plans private consumers are accustomed to.

So far HHS has only agreed to review the proposed Obamacare Medicaid expansion private option and there is no guarantee it will be accepted.

Then there is this . . .
 Medicaid typically pays hospitals and doctors much less than average. A beneficiary costing the government $6,000 a year for Medicaid would cost $9,000 on a private plan on the exchange, the Congressional Budget Office has estimated. On the other hand, Arkansas officials have suggested that competition among insurers and providers for Medicaid patients could keep the cost from being prohibitive or even save money eventually.
Again, sounds good on paper but the envisioned competition among carriers for exchange based business will not materialize.

You can bank on that.

+Bob Vineyard #Obamacare #Medicaid
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