Patient Protection and Affordable Care Act: State Action Newsletter
August 17, 2012
Medicaid Expansion ‘Voluntary’
The expansion of Medicaid under the Patient Protection and Affordable Care Act is “truly voluntary,” the director of the Centers for Medicaid and Children’s Health Insurance Program Services announced during NCSL’s Legislative Summit last week.
“You can come in, in time for January 2014. You can come in later, if you choose to. You cannot come in at all, if you choose to. And if you come in, you can choose to leave. We think that is consistent with the nature of the court's decision to make it a voluntary program,” Cindy Mann told lawmakers.
Mann, representing the Centers for Medicare and Medicaid Services (CMS), also told NCSL Summit participants that no deadline had been established for states to decide on the Medicaid expansion. Under the law, Medicaid is set to expand to cover people with incomes up to 133 percent of the federal poverty level in 2014. However, the Supreme Court ruled that the federal government could not withhold existing Medicaid funding for states that decline to expand their eligibility, leaving the choice to the states.
The CMS announcement will help states make important decisions on how they will move forward, but states have a lot of factors to consider when deciding what is best for the Medicaid program and for their constituents.
“Most states are taking their time to look and consider and think about what it means, how many people, what the dollars are, what the options are. We strongly encourage you to do just that. And we want to be very helpful as you do that,” said Mann.
CMS’s decision to release this information at NCSL’s Legislative Summit made it clear that state legislatures will play a key leadership role in choosing the future of Medicaid programs.
Inside This Issue
Analysis Concludes that a California Basic Health Program Would Increase Coverage
A Basic Health Program in California would potentially increase health insurance coverage overall by 60,000 to 120,000 people by 2019, compared to the Health Benefit Exchange and subsidies alone, concludes an analysis of the program.
Created by PPACA as a state option, the Basic Health Program (BHP) is designed to improve consistency of health coverage for low-income individuals whose income falls between 133 percent and 200 percent of poverty including legal permanent residents otherwise ineligible for Medicaid.
The analysis concluded the BHP would reduce the size of the Exchange by between 720,000 and 950,000 people, which could limit the Exchange’s bargaining power. The BHP would not affect the risk mix in the Exchange and individual market, according to the report.
The study assumes that BHP enrollees would pay a $20 monthly premium per person, which may be lower than the actual premium in 2019. This assumption is important because as premiums increase, the gains in coverage decrease. However, if the BHP premium is lower than assumed in the study, additional people would likely gain coverage.
The potential increase in ‘churn’ between programs is also highlighted. Requiring people to re-enroll in each program as their income changes—between BHP coverage and Medicaid as income decreases, or BHP coverage and the Exchange as income increases—would create unnecessary administrative barriers to continuous coverage. The report asserts that such barriers can be minimized if churn between programs is made as seamless as possible.
CDC Obesity Data: Colorado Thinnest, Mississippi Most Obese
Colorado is the nation’s thinnest state and Mississippi is the most obese according to the Centers for Disease Control and Prevention’s 2011 data on obesity prevalence for U.S adults, which was released earlier this month. Obesity is defined as a body mass index (BMI) of 30 or greater. Colorado’s rate for obesity among adults is 20.7 percent and 34.9 percent of adults in Mississippi are obese. Southern states dominate the list of states with an obesity prevalence of 30 percent or more among adults. In addition to Mississippi, that group comprises Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Missouri, Oklahoma, South Carolina, Texas and West Virginia. In 2000, no state had an obesity prevalence of 30 percent or more.
To address the rise in obesity, the PPACA supports prevention efforts that improve access to healthy, affordable foods and safe places to be active through its authorization of the Childhood Obesity Demonstration Project, Community Transformation Grants and the National Prevention Strategy. Other PPACA efforts to address obesity include providing financial incentives to Medicaid enrollees for adopting healthy behaviors and allowing employers to increase financial incentives under employee health insurance plans for meeting certain health-related standards, such as maintaining a healthy weight. The law also requires new health plans to cover a number of preventive services at no cost to the patient, including counseling on diet and weight loss and managing obesity.
Prevalence of Self-Reported Obesity Among U.S. Adults by State
Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System 2011.
Health Reform Act Increases Insurance Coverage for Young Adults says New Report
Insurance coverage for young adult dependents up to age 26 increased by 5.3 percentage points due to the implementation of the Patient Protection and Affordable Care Act (PPACA), according to a working paper from the National Bureau of Economic Research. The researchers evaluated the interaction between existing state laws that expand dependent coverage to young adults and the federal health reform provision that permits young adults up to age 26 to enroll as dependents on a parent’s private health plan. The report also concluded that PPACA implementation resulted in a 3.5 percentage point decline in the uninsured rate of the young adult population. “The interaction between state laws and the ACA suggests that the increase in dependent coverage and decline in the uninsured rate may have been greater among young adults who were targeted by both the PPACA and state laws,” according to the report. The report is available for a $5.00 fee.
Medicaid a Major Topic at the NCSL Legislative Summit
Sessions ranging from innovative state-driven Medicaid redesigns to methods for encouraging smoking cessation among Medicaid enrollees made the future of Medicaid a major topic during the NCSL’s 2012 Legislative Summit in Chicago. Presenters included legislators, legislative staff, senior Obama administration officials, researchers and state Medicaid officials. While the topics were diverse and the opinions divided, a few themes emerged: states want more value for their Medicaid dollar investments; states are innovating ways to align their payment incentives with their desired outcomes; state legislatures play an important role in the Medicaid program and they want to be involved in designing more effective and efficient programs; and the next few years will be important for this ever-evolving program. Read more about all of the health sessions and view PowerPoint presentations.
Health Care Law after the Court Decision: What is Next?
The NCSL Task Force on Health Reform Implementation met at the 2012 Legislative Summit to discuss the issues, opportunities and challenges posed by the Supreme Court’s decision to uphold most of the Patient Protection and Affordable Care Act. Visit the archives of this meeting to read session descriptions and view presentations.
Colorado CO-OP Receives $69 Million Loan From Health and Human Services
The Colorado Health Insurance Cooperative has received a $69 million low-interest loan from the U.S. Department of Health and Human Services (HHS) for statewide implementation of the latest Consumer Operated and Oriented Plan (CO-OP). The Colorado CO-OP's mission is to provide quality and affordable health insurance to both individuals and small businesses and to participate in the Colorado Health Benefit Exchange. The CO-OP will operate as a non-profit entity governed by its participants. The CO-OP will begin marketing its insurance products in 2013 and coverage is expected to begin on Jan. 1, 2014. Sponsors hope for more than 10,000 insured by the first year.
For a full list of awardees and more information about CO-OPs, visit the federal fact sheet.