Medicaid Opportunities & Challenges Task Force June 25, 2013 Jeff Bechtel, Senior Consultant Update of Research Findings: Economic, Health and Personal.

Medicaid Opportunities & Challenges Task Force

June 25, 2013

Jeff Bechtel, Senior Consultant

Update of Research Findings: Economic, Health and Personal Financial Impacts of Medicaid Expansion

• Reviewed summary of findings (e.g. mortality, access to care, recent Oregon study)

• Asked to “double check” findings

• Requested feedback, suggestions

Summary of Last Meeting

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• Research – Opposing Views

• “Deeper Dive” into Oregon Findings

Today’s Presentation

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• Performed research relating to quality and access in the Medicaid Program

• Reviewed reports, data prepared by organizations and think tanks opposed to Medicaid expansion (e.g. Heritage Foundation, Cato Institute)

• Summarized findings from recent document issued by Heritage Foundation• Kevin Dayaratna, “Studies Show Medicaid Patients Have Worse Access and Outcomes

than the Privately Insured,” Heritage Foundation Backgrounder No. 2740, November 7, 2012, http://www.heritage.org/research/reports/2012/11/studies-show-medicaid-patients-have-worse-access-and-outcomes-than-theprivately-insured

The Case Against Medicaid

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• Adequate access to care is a problem for children on Medicaid:• 2001 Study – Children with Asthma on Medicaid receive less effective care than

Children with Asthma on private insurance

• 2004 Study – Specialty Surgeons in California less likely to accept children enrolled in Medicaid, compared to private insurance

• 2005 Study – Urologic offices less likely to accept children enrolled in Medicaid, compared to private insurance

• 2006 Study – Disparity between access to specialty care for privately insured children in Cook County Illinois compared to privately insured individuals

Report Summary

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• There are health disparities between adult Medicaid recipients and individuals who are privately insured.

• Medicaid recipients have significantly more difficulty accessing specialty care than privately insured patients.

• Nearly one-third of physicians nationwide will not accept new Medicaid patients.

Report Summary (cont’d)

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• Medicaid Programs and reimbursement rates vary by state – difficult to generalize from state to state.

• Comparisons are between Medicaid and private insurance, not Medicaid and no insurance at all.

• There are competing studies relating to Medicaid access to care, demonstrating that access for individuals on Medicaid and private insurance are roughly equivalent:

• Kaiser Report: http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8000-02.pdf

• MACPAC Report: https://docs.google.com/viewer?a=v&pid=sites&srcid=bWFjcGFjLmdvdnxtYWNwYWN8Z3g6MzM2ZWM3ZjlhMDI1ZGFhNw

• Discussion

Observations

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• During the last meeting, we reviewed a NEJM study that found that Medicaid coverage is Associated with Lower Rates of Death. See: Benjamin D. Sommers, M.D., Ph.D. et al., Mortality and Access to Care Among Adults After Medicaid Expansions, NEJM. (July 25, 2012).

• Study Summary:

• Reviewed 3 states with waivers to cover low-income adults: Arizona, Maine and New York.

• Findings - Compared to neighbor states, adults with Medicaid experienced:

• Reduction in mortality (-6.1% or 19.6 deaths/ 1,000)

• Less delayed care due to cost (-21%)

Follow-up: Mortality Study

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• Study observations – Michael Cannon, CATO Institute

• Study comes with caveats: the results “may not be generalizable to other states,” may have been driven by unobservable confounding factors.

• Program spends nearly half a trillion dollars per year.

• Other strategies could save more lives per dollar spent than expanding health insurance.

• Source: http://www.cato.org/blog/460-billion-year-medicaid-darn-well-better-save-lives

Follow-up – Mortality Study (cont’d)

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• Discussed findings during last meeting.

• Additional study observations from commentators:

• Preventive care isn’t always effective.

• Quality in health care is a problem; a focus should be placed on paying for outcomes. This problem isn’t unique to Medicaid.

• Healthcare coverage doesn’t automatically eliminate factors like lack of education, lack of access to healthy food and household financial strain that can impact health and health management.

• Insurance is about health, but it’s also about money.

• The study didn't measure overall health status and the effects over time. Rather, it included only a few measures, such as blood pressure, cholesterol and blood sugar levels, over only two years.

• Additional, and more conclusive, information will be available over time.

Oregon Study Observations

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Discussion

Questions?

Sellers Dorseysellersdorsey.com

Jeff BechtelSenior ConsultantSellers [email protected]

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