Category: Curator

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

Curator summary

Medicaid expansion contributed to increased shortfalls in hospital revenues (because of lower reimbursement)- and led to a bed-shortage in expansion dates during the COVID pandemic.

Clipped from: https://www.detroitnews.com/story/opinion/2020/12/08/opinion-medicaid-expansion-states-less-prepared-covid-19/6494763002/

As I scrolled through Twitter Monday morning, a news headline caught my attention: “Southern Colorado Hospitals Reach ICU Bed Capacity As COVID Hospitalizations Continue To Rise.”

Indeed, from New York to New Mexico, the ability of hospitals to house additional COVID-19 patients across the country is a major concern.

Unfortunately, this is less a feature of the COVID-19 pandemic, and more a symptom of how hospital bed capacity has diminished quietly over the past two decades.

According to data from the American Hospital Association, the number of hospital beds per thousand persons fell by more than 16% between 2000 and 2017. Some states have seen double-digit declines in bed space over the past five years alone. This problem was brewing long before the virus hit U.S. soil.

However, some states have weathered the crisis better than others. States entering into this pandemic with greater hospital bed capacity have had an advantage.

Contrary to popular myth, states that expanded Medicaid under Obamacare have been faced with greater constraints on hospital and ICU beds, while non-expansion states have been better equipped to confront the pandemic with more capacity and better resources.

How did we get to this point? Medicaid expansion provided welfare to able-bodied adults in states that chose to adopt it, but because Medicaid reimburses medical providers at far lower rates compared to private insurers — and in many cases below the actual cost of care — hospitals in these states have seen their resources dwindle as they take on more patients at lower rates.

It’s no surprise that since Medicaid expansion was adopted, hospitals’ collective Medicaid shortfalls have skyrocketed by $5 billion, or more than 50%. 

These unfortunate financial realities have forced many expansion states’ hospitals to close their doors completely. Others were unable to invest in additional capacity, contributing to the decline in bed space.

The proof is in the data. According to a study I co-authored, since 2013, the number of hospital beds per capita has declined by more than 6% in Medicaid Expansion states — while the number of beds has increased in non-expansion states. 

Today, non-expansion states have 510 more beds per capita than their expansion counterparts. And it’s not just beds — states that have resisted Obamacare’s Medicaid Expansion have 35% more hospitals per capita compared to expansion states.

We’re seeing this unfortunate reality play out in real time. According to data from the Department of Health and Human Services (HHS), the only states with more than 90% of their staffed adult ICU beds occupied — New Mexico, Rhode Island and North Dakota — have one thing in common: They all expanded Medicaid under Obamacare.

These otherwise unrelated states — with unique regions, demographics, economies, populations and health characteristics — are bonded together by the same decision to expand Medicaid, which has manifested itself in reduced bed capacity for COVID-19 patients.

The Medicaid expansion state of Colorado — the focus of the news headline — went into this national health crisis with less than half of the bed capacity of bordering Wyoming, a non-expansion state. According to the HHS data, Colorado presently has nearly 70% of its staffed ICU beds occupied, while Wyoming has roughly half of its beds occupied — the second lowest level in the nation. Had Colorado chosen to follow Wyoming’s lead and resist the adoption of Medicaid expansion under Obamacare, the situation would have been far different. 

As policymakers gear up for the start of legislative sessions, there’s an important lesson in this analysis: Don’t fall for the myth that Medicaid expansion is a cure-all, especially for hospitals.

Rejecting Obamacare’s expansion is a commonsense step states can take to avoid the harsh reality they could otherwise be forced to reckon with.

Hayden Dublois is a research analyst at the Foundation for Government Accountability. He wrote this for InsideSources.com.

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

Curator summary

SCOTUS will hear a case to determine whether work requirements can be used in the Medicaid program.

Clipped from: https://www.healthcarefinancenews.com/news/supreme-court-consider-medicaid-work-requirements

Late last week, the Supreme Court agreed to decide whether outgoing President Donald Trump and his administration can allow states to tack work requirements onto their Medicaid programs, a proposal that has been shot down in the lower courts.

At issue is the administration’s approval of Medicaid work requirements in Arkansas and New Hampshire. In a brief order, the Justices granted review in Azar v. Gresham and Arkansas v. Gresham, and consolidated the cases for an hour of oral argument. The Justices are being asked to decide whether the U.S. Court of Appeals for the District of Columbia erred in concluding that the secretary of Health and Human Services may not authorize demonstration projects to test the work requirements to facilitate the transition of Medicaid beneficiaries to commercial coverage.

WHAT’S THE IMPACT?

Work requirements have been controversial in some states. In February, for example, a federal appeals court ruled that the Trump Administration unlawfully allowed Arkansas to implement a work requirement on those covered under that state’s Medicaid expansion program, echoing a lower court ruling from 2019.

Arkansas was the first state to create such a work requirement, tasking enrollees aged 19-49 with clocking 80 hours per month on work, volunteering or job hunting, which then had to be reported via Internet or phone. According to Arkansas Online, 18,164 people lost coverage during the nine months the requirement was in effect, and were barred from re-enrolling for the remainder of the year.

The unanimous decision in the Arkansas case, written by Reagan appointee Judge David Sentelle, upheld a district court ruling that found the administration had not analyzed whether work requirements would promote the primary objective of Medicaid, which is to “furnish medical assistance.”

In issuing approvals of state work-requirement waivers, the administration had argued that the move would help some beneficiaries transition to private policies and could lead to better health outcomes, and help states conserve financial resources, CNN reported. The administration began granting state work requirement requests in 2018.

According to a blog on the Supreme Court’s website, the cases will likely not be argued until late winter or early spring. On Friday, law professor Stephen Vladeck said on Twitter that President-elect Joe Biden could rescind the government’s approval of work requirements when he takes office, although this would likely take time, opening up the possibility that the state would pursue an administrative hearing to challenge any rescission. 

In Arkansas, more than 18,000 people lost coverage in 2018 before the courts stepped in.

THE LARGER TREND

In October, the Centers for Medicare and Medicaid Services’ announcement of work requirements in Nebraska drew push-back from Nebraska Appleseed, a nonprofit focused on, in part, promoting access to affordable healthcare. It called the Heritage Health Adult waiver “unnecessary” and “a step in the wrong direction.”

Similar requirements were recently introduced in Georgia. Specifically, CMS announced the approval of Georgia’s new Medicaid section 1115 demonstration called “Pathways to Coverage.” It requires working-age Georgia adults who are ineligible for Medicaid to opt into Medicaid coverage by participating in qualifying activities such as work and education, as well as meeting premium and income requirements.

This applies to those between the ages of 19 and 64, with income up to and including 100% of the federal poverty level, and is effective through September 30, 2025, with implementation beginning July 1, 2021.
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com