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Medicaid Expansion. Jill Beiser, Kathleen Power, & Megan Reid. Problem Identification. Patient Protection and Affordable Care Act, aka Obamacare. Affordable health insurance for ALL! Tax credits Tax breaks Health insurance exchanges Choice of the States - The Problem. Background - Social. - PowerPoint PPT Presentation
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Medicaid Expansion
Jill Beiser, Kathleen Power, & Megan Reid
Problem Identification Patient Protection
and Affordable Care Act, aka Obamacare.
Affordable health insurance for ALL! Tax credits Tax breaks Health insurance
exchanges Choice of the States
- The Problem
Background - SocialEnacted in 1965 Initially, a medical care extension of
programs providing assistance for poor Emphasis on children, their mothers,
disabled, and elderlyGradually expanded Medicaid’s
beneficiaries from 4 million to nearly 60 million (Kaiser Commission, 2011)
Background - Economic Federal government pays a share of medical
assistance expendituresDetermined annually comparing state’s
average per capita income level with national income levelHigher per capita income level reimbursed
less Enrollment grown over 7 million since 2007 Major item in federal and state budget
3rd largest domestic program in federal 2nd largest program in most states
Background - EthicalEthical issues
Moral foundations, cost containment, public health, and access to care
Primary ethical issueDistributive justice
Is health care a right or an option?
Background - Legal Payment reform. New reimbursement structures. Access to program participation in Medicaid
and health insurance exchanges and products.
Background - Political Republican vs. Democratic views. Massachusetts’ formula. Where does Kansas stand?
Issue StatementHow can the federal and state
governments implement changes to Medicaid in order to provide adequate health insurance to impoverished citizens without causing the state or federal
governments unreasonable debt?
StakeholdersAll U.S. citizens under the age of 65
with family incomes < 133% of the federal poverty level (Medicaid, 2013)
Federal governmentStatesTaxpayersHospitalsPhysicians/NP’s/PA’s
Policy Objectives1) Expand Medicaid coverage to all
individuals up to age 65 with incomes <133 % of the federal poverty level
2) Establish policies at the state level that increase funding for Medicaid expansion in line with the ACA.
3) Develop legislation at the federal level and agreements between states to ensure short-term and long-term federal funding for Medicaid expansion
Policy Objectives cont.4) Structure priorities and policies at the
state level that reflect citizens needs and support expanded coverage while remaining financially sound.
5) States periodically update and refine their budget for Medicaid as the nature and cost of healthcare changes in order to maintain the same level of care for their citizens.
Policy Alternatives Do Nothing
Option Incremental
Change Option Major Change
Option
Evaluation Criteria 1) The probability of states being able to
support the financial responsibilities of decision about Medicaid expansion and alternatives.
2) The efficacy and affordability of proposed plan to the citizens of the United States.
3) The ability of the plan to meet the healthcare demand of current and future population needs.
4) Political feasibility for state and federal governments.
Analysis of Option 1: The Do Nothing Option
Criterion 1: States able to support financiallyPro: States avoid relying on federal moneyCon: Does not fix or help decrease cost
Criterion 2: Efficacy/affordability to citizensPro: Keep tax increases to a minimum and
allows states to focus on other prioritiesCon: Raise health insurance and decrease
insured
Analysis of Option 1: The Do Nothing Option
Criterion 3: Meet healthcare demandPro: Decrease strain on primary care
providersCon: Demand for healthcare unchanged
Criterion 4: Political FeasabilityPro: Follows current institutional structure
Government tends to favor status quo over changeCon: Acts against majorly agreed upon belief
that healthcare is a broken system
Analysis of Option 2: Incremental Change
Option Criterion 1: States able to support
financiallyPro: Allows states to receive some federal
fundingCon: If federal funding reneged, states
bear burden Criterion 2: Efficacy/affordability to
citizensPro: Increases access and minimizes costsCon: Less money to other priorities and
tax increases
Analysis of Option 2: Incremental Change
Option Criterion 3: Meet healthcare demandPro: Increased accessibility/affordability
and focus on preventionCon: Further shortage of PCPs, increased
strain, decreased hospital productivity Criterion 4: Political Feasibility
Pro: Allows for shared costs and independence of states
Con: Requires agreement and has less clear guidelines related to federal funding
Analysis of Option 3: Major Change Option
Criterion 1: States able to support financiallyPro: Increases federal fundingCon: Maximizes federal government spending
and may fall back onto states Criterion 2: Efficacy/affordability to citizens
Pro: More money to other state priorities, minimize tax increases, affordable health care
Con: May still lead to tax increases and increases to already insured plans
Analysis of Option 3: Major Change Option
Criterion 3: Meet healthcare demandPro: Increase in insuredCon: Does not address shortage of PCPs
Criterion 4: Political feasibilityPro: Realigns federal and state
responsibilities with use of increased federal matching
Con: Requires more stringent funding guidelines and requires agreement
Comparison of Policy Alternatives
Tie between Alternatives 2 and 3Alternative 2 is more politically
feasible but alternative 3 has stronger ability to meet current/future needs of U.S. citizens
Alternative 3 requires the most funding from federal government but frees states’ resources.
Comparison of Policy Alternatives
Do Nothing Option
Incremental Change Option
Major Change Option
CriteriaFunding + + ++Continuation of Funding
+ + +
Ability to Meet Current/Future Demands
- + ++
Political Feasibility
++ + -
4+/1- 4+/0- 5+/1-Score for Each Alternative
3 4 4
Summary/Recommendations
Medicaid expansion will provide eligibility to all people under 65 with incomes <133% of the (FPL).
Opens up eligibility to Millions of low-income adults without children, low-income parents, children who are now on CHIP
Expected to cover an additional 16 million people by 2019 (Kaiser, 2010).
RecommendationsAlternative 2, the Incremental Change
Option is more politically feasible A systems design would allow for sharing
between states and the federal government
Option 2 increases health insurance for millions of people
More focus on prevention means less visits to ER
References The Advisory Board Company. (2013). Where each state stands on ACA’s Medicaid expansion.
Retrieved from http://www.advisory.com/Daily-Briefing/2012/11/09/MedicaidMap American Public Health Association (2013). Medicaid Expansion. Retrieved March 5, 2013 from
http://www.apha.org/advocacy/Health+Reform/ACAbasics/medicaid.htm. American College of Emergency Physicians. (2011). Ethics of health care reform: Issues in emergency
– medicine – An information paper. Retrieved from www.acep.org/Content.aspx?id=80871. Association of American Medical Colleges. (2010). Physician shortages worsen without increase
residency training. Retrieved from https://www.aamc.org/download/153160/data/physician_shortages_to_worsen_without_increases_in_residency_tr.pdf
Galewitz, P. (2012). Study: Nearly a third of doctors won’t see new Medicaid patients. Kaiser Health News. Retrieved February 6, 2013 from http://www.kaiserhealthnews.org/stories/2012/august/06/third-of-medicaid-doctors-say-no-new-patients.aspx
The Heritage Foundation. (2013). Medicaid expansion in Kansas: Impact and cost to taxpayers. Retrieved from http://www.heritage.org/multimedia/infographic/2013/03/medicaid-expansion/kansas.
Holahan, J. (2009). Alternatives for financing Medicaid expansions in health reform. Kaiser Commission on Medicaid and the Uninsured. Retrieved from
http://www.kff.org/healthreform/upload/8029.pdf
References Kansas Health Institute New Service. (2012). Brownback says no again to health insurance exchanges.
Retrieved from: http://www.khi.org/news/2012/nov/08/brownback-says-no-again-health-insurance-exchange/. Kaiser Commission. (2010). Medicaid coverage and spending in health reform: National and state-by-state
results for adults at or below 133% FPL. Retrieved from http://www.kff.org/healthreform/upload/medicaid-coverage-and-spending-in-health-reform-national-and-state-by-state-results-for-adults-at-or-below-133-fpl.pdf
Kaiser Commission. (2011). Medicaid and the uninsured. Retrieved from http://www.kff.org/medicaid/upload/8165.pdf
Kaiser Family Foundation (2012). The Health Reform Law’s Medicaid Expansion: A Guide to the Supreme Court Arguments. Retrieved March 5, 2013 from http://www.kff.org/healthreform/upload/8288.pdf.
Lachman, V. D. (2009). Ethical challenges in healthcare: Developing your moral compass. New York, NY: Springer.
Lachman, V. D. (2012). Ethical challenges in the era of health care reform. Medsurg Nursing 21(4). Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Resources/Ethical-Challenges-in-the-Era-of-Health-Care-Reform.pdf.
Medicaid (2013). HealthCare.gov. Retrieved February 5, 2013 from http://www.healthcare.gov/using-insurance/low-cost-care/medicaid/
National Association of Public Hospitals and Health Systems (2012). Medicaid expansion benefits everyone. Retrieved February 5, 2013 from http://www.naph.org/Homepage-Sections/Advocate/Medicaid-Expansion-Benefits-Everyone.aspx?FT=.pdf
References Kaiser Commission. (2011). Medicaid and the uninsured. Retrieved from
http://www.kff.org/medicaid/upload/8165.pdf Nordal, K.C. (2012). Healthcare reform: Implications for independent practice. Professional
Psychology: Research and Practice, 43(6): 535-544. Oberlander, J. (2012). The future of Obamacare. New England Journal of Medicine, 367(2): 2165-
2167. The Patient Protection and Affordable Care Act, 42 U.S.C. 300gg et seq. (2010). Retrieved from
http://www.gpo.gov/fdsys/pkg/BILLS-111hr3590enr/pdf/BILLS-111hr3590enr.pdf Social Security Administration. (2012). Annual statistical supplement to the social security bulletin,
2011 (SSA Publication No. 13-11700). Washington DC. United States Census Bureau. (n.d.). Health insurance highlights: 2011. Retrieved from http://
www.census.gov/hhes/www/hlthins/data/incpovhlth/2011/highlights.html U.S. Department of Health and Human Services. (n.d.) Read the Law. Retrieved from
http://www.healthcare.gov/law/full/ U.S. News & World Report (2013). Is Medicaid expansion good for the states? Retrieved February
5, 2013 from http://www.usnews.com/debate-club/is-medicaid-expansion-good-for-the-states Wilson, M. (2013). Lawmakers urge final answer on Medicaid expansion. State house sound bites.
Retrieved February 5, 2013 from http://www.witf.org/state-house-sound-bites/2013/02/lawmakers-urge-final-answer-on-medicaid-expansion-1.php
Wichita Eagle (2013). Eagle editorial: Medicaid expansion boosts state. The Wichita Eagle. Retrieved March 5, 2013 from http://www.kansas.com/2013/02/21/2683996/eagle-editorial-medicaid-expansion.html.
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