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Monday Morning Medicaid Must Reads: July 3rd, 2017

Helping you consider differing viewpoints. Before it’s illegal. 

 

Article 1: Are Medicaid patients more likely to die than uninsured, as Heritage Action CEO says? Politifact, June 28th, 2017, Amy Sherman

Clay’s summary: I think most “fact-checking” sites (unfortunately including Snopes) have become pretty biased, but this is a decent article. Makes a good case for diving deeper on true impact of Medicaid on health outcomes. Too simple to say “Medicaid makes outcomes worse.” But also too simple to say “Millions will die without Medicaid.”

Key Passage from the Article

 

“This implication that somehow you get worse care with an insurance plan — Medicaid — than you would by not having an insurance plan at all — no coverage, just going to the ER for emergencies — for most reasonable people that doesn’t make any sense,” he said.

PolitiFact has previously found at least seven academic papers that detected a link between securing health insurance and a decline in mortality. In general, these papers present a stronger consensus that having insurance saves lives.

Harvard researchers recently wrote a piece summarizing the evidence on the effect of Medicaid or other insurance on mortality. Their review of the evidence concludes that insurance like Medicaid significantly reduces mortality relative to being uninsured, said Katherine Baicker, one of the authors. The researchers found that “coverage expansions significantly increase patients’ access to care and use of preventive care, primary care, chronic illness treatment, medications, and surgery. These increases appear to produce significant, multifaceted, and nuanced benefits to health.”

Read it here 


Article 2: Republicans are trying to undo Obama’s Medicaid disaster, NY Post, Besty McCaughey, June 27th, 2017

Clay’s summary: The idea that Medicaid today is not what it was ever intended to be is lost on most. Part of the reason is because we are such a wealthy nation we have lost all concept of what true poverty is. Today’s middle class now thinks of itself as poor.

Key Passage from the Article

Medicaid was created in 1965 as a safety net for the poor. But ObamaCare distorted it, edging the US health-care system closer to a Medicaid-for-all or single-payer system. Swelling the Medicaid rolls — instead of making private insurance affordable — was the main trick ObamaCare used to boost the number of insured.

A whopping 75 million people are now enrolled on Medicaid, 20 million more than in Medicare, the program for the elderly. If the repeal bill doesn’t pass, Medicaid enrollment will soar to 86 million by 2026, according to a Congressional Budget Office analysis released Monday.

Who’s picking up the tab for this vast Medicaid expansion? You. Worse, you pay twice — once as a taxpayer, then again as an insurance consumer.

Families with private insurance pay $1,500 to $2,000 or more in added premiums yearly already to keep Medicaid afloat. The more Medicaid expands, the higher their premiums will go.

That’s because Medicaid shortchanges hospitals and doctors, paying less than the actual cost of care. They make up for it by shifting the costs onto privately insured patients. Ouch.

That cost-shifting only works until Medicaid enrollment grows too large. The Mayo Clinic warned three months ago that Medicaid enrollment has reached the tipping point. The renowned clinic announced it will have to turn away some Medicaid patients, or put them at the back of the line, behind patients with private insurance.

 

Read it here

 


Article 3: Veterans Helped By Obamacare Worry About Republican Repeal Efforts, NPR, Stephanie O’Neill June 28, 2017 

Clay’s summary: I recently learned that vets have to pay premiums for their healthcare. And I am still angry about that so hard for me to summarize this article. Can we make their care free before we cover everyone else in Medicaid?

Key Passage from the Article

There are about 22 million veterans in the U.S. But less than half get their health care through the Veterans Affairs system; some don’t qualify for various reasons, or may live too far from a VA facility to easily get primary health care there.

Many vets instead rely on Medicaid for their health insurance. Thirty one states and the District of Columbia chose to expand Medicaid to cover more people — and many of those who gained coverage are veterans.

The GOP health care bill working its way through the Senate would dramatically reduce federal funding for Medicaid, including rolling back the expansion funding entirely between 2021 and 2024.

Medicaid coverage recently has become especially important to Ramos — a routine checkup and blood test this year showed he’s infected with hepatitis C. California was one of the states that chose to expand Medicaid, and the program covers Ramos’ costly treatment to eliminate the virus.

“Right now, I’m just grateful that I do have it,” he says. “If they take it away, I don’t know what I’m going to end up doing.”

Read it here

 


Article 4: Cardiac Arrests Dropped Under Obamacare Medicaid Expansion, Forbes, Tara Helle, June 29, 2017

Clay’s summary: There are clearly specific procedures and conditions improved by having easier access to care. Can we focus on those?

Key Passage from the Article

Cardiac arrests among previously uninsured middle-aged adults dropped by 17% after they got insurance through the Affordable Care Act, or Obamacare, a new study shows. The incidence of cardiac arrests remained the same among adults age 65 and older, a group that had consistently high rates of health insurance coverage before and after the ACA, primarily through Medicare.

“The fact that was this decrease was not observed in the elderly, who have near-universal access to healthcare, makes the availability of insurance one of the likely causes of the drop in cardiac arrest rate,” said lead author Eric Stecker, MD, MPH, an associate professor of cardiology at Oregon Health & Science University in Portland. “This study reinforces the results of prior studies which have shown that pretty consistently giving access to insurance significantly improves engagement in preventive care.”

Read it here

 


Article 5: Why the fear-mongering on Medicaid is totally overblown, Washington Post, June 28th, 2017

Clay’s summary: You might want to put down your Andy Slavitt, Michael Moore, and KFF Foundation echo-chamber devices (twitter feeds) before reading this one. And if they find out you read this one, you’re totally kicked out of the #Resist club.

Key Passage from the Article

A recent New York Times op-ed from three health-care experts described the effort as a “direct attack on our elderly, our disabled and our dignity.” A Post commentary charged lawmakers with “gutting Medicaid so they can give a giant tax break to their billionaire buddies,” threatening life-saving treatments for a young boy with a congenital heart condition. A long-time political adviser charged on national television that sponsors would “kick some kid out of his wheelchair.” And a left-leaning think tank further upped the ante by publishing contrived estimates of the numbers of people (handily broken down by state) who will supposedly be killed by the proposed legislation.

You don’t need to support the pending health-care bills to recognize they bear little resemblance to this explosive rhetoric, nor do you have to support the legislation to realize that our deteriorating political environment is making it impossible to make policy decisions with the appropriate reflection and care.

 

 

Read it here

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Weekly Medicaid RoundUp: Week of June 26th, 2017

Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2u5LKtU

For optimist readers- http://bit.ly/2u2PRXL (a poppy bit for your vacation trip)

 

SHAMELESS PLUG FOR OUR NEW ONLINE TRAINING COURSE: Check it out. We released it after years in the making. Here’s the video ad for it- http://bit.ly/2twQCeF

I WILL BE AT MHPA 2017, WILL YOU? Chairing a Medicaid Director’s panel. Would love to see you there. You can check it out here – http://bit.ly/2twCi5L

DETAILS OF THE SENATE BILL THAT WILL KILL EVERYONE 4 TIMES OVER AND ALSO INCREASES CLIMATE CHANGE AND ALSO EVERY OTHER BAD THING WE CAN TACK ON TO THIS BILL THAT STOPS THE SPENDING ORGY WE HAVE ALL ENJOYED FOR DECADES, UNINTERRUPTED (BUT WE LOOKED NOBLE DOING IT, AND ALWAYS CLAIMED MORAL SUPERIORITY, SO WE’RE TOTES GOOD, RIGHT?) – Long headline, short link to good analysis on the timeline for the BCRA funding changes: http://bit.ly/2u1CDKM  Here is another one that compares the House and Senate bills in case you are into that sort of thing: http://bit.ly/2twMXxs

 

YEAH, BUT HOW DID WE GET HERE? As part of the frenzy to show what all problems Medicaid can solve, DJs have put the “Caid can solve the opioid crisis” EP back into the rotation. My suspicion is if you look at a chart oxycontin, et al volume over the last 20 years and slapped a category for payer on it that Medicaid funded the current opioid crisis. Am I crazy to think this? Write in and do tell.

 

IT’S THE BIG ONE, ELIZABETH! Please tell me you get the reference. Assuming you do, I am suddenly struck by the richness of what we all share via pop culture. Anyways… OR Caid has studies out now showing a 17% drop in cardiac arrests after expansion. Once patients got an insurance card in their pockets, they delayed care less and had that chest pain checked out.

 

MCOS IN ILLINOIS: MAY NEED TO WRITE THIS ONE OFF ON YOUR TAXES- IL State Attorney Stratton told a judge this week that the state simply does not have the cash to pay its Medicaid costs (as was asked by a recent Medicaid member lawsuit in response to the state not paying providers and MCOs). The lawsuit asked IL to pony up $500M more a month to get caught up. Stratton says the state may be able to come up with $150M a month for the pay-your-freaking-tab effort. Fortunately, healthcare superheroes from CA and NV flew in and paid for it out of their own pocket (they had a ton left over once their single-payer bills failed last week). Just kidding, we all know Bernie wrote the check.

 

SHOW ME STATE WANTS TO UN-SHOW EXPANSION- MO reps voted to freeze Medicaid enrollment in the expansion group to try and help deal with their budget crisis. All analysts expect this to trigger a fight with the Good Guvn’r Kasich.
CENTENE GOES ON PROBATION IN THE CORNHUSKER STATE- Seems the state is unhappy with the plan’s troubles getting behavioral health and home health providers paid.

FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Rabbi Zalmen Sorotzkin of Lakewood, NJ was popped this week for leading a $1M fraud bilking Medicaid and other benefit programs. Cheryl Mcgrath of Guysville, OH plead guilty this week to using her home health care company steal $2M from Medicaid via false claims, including for dead people or people in nursing homes at the time she claimed to be providing home health services. Anthony Handal and his fiancé Sandra Mora of Orlando, FL billed Medicaid for $160k of intensive family case management services they never provided. They would conduct an initial meeting with the Medicaid-enrolled families to get their member numbers, then never do anything else to help them (but billing FL Medicaid for 3 sessions a week for the family). Collins Anyanwu-Miller of Bridgeport, CT was arraigned this week for stealing $390k from Medicaid by falsifying home care claims. Mr. Anyanwu-Miller even managed to get paid for home care services that occurred while he vacationed in Europe. Mrs. Mcgrath- you win! (Taxpayers, you lose! Total tab this week: $3.6M).

 

That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (when the rain stops) and keep running the race (you know who you are).

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Medicaid Acronym of the Day- MMIS

Medicaid Management Information System – The MMIS is an integrated group of procedures and computer processing operations (subsystems) developed at the general design level to meet principal objectives. For Title XIX purposes, “systems mechanization” and “mechanized claims processing and information retrieval systems” is identified in section 1903(a)(3) of the Act and defined in regulation at 42 CFR 433.111. The objectives of this system and its enhancements include the Title XIX program control and administrative costs; service to recipients, providers and inquiries; operations of claims control and computer capabilities; and management reporting for planning and control.

Further reading 

https://www.medicaid.gov/medicaid/data-and-systems/mmis/modules/index.html