Medicaid Expansion Who’s Being Robbed?


I would like to refer to the Wall Street Journal articles “Obama Care is Robbing Medicaid’s Sickest Patients” by Alyssa Finley and “America Is Running Out of Family Caregivers, Just When It Needs Them Most” by Clare Ansberry.

These two articles describe the position that those who are against Medicaid Expansion in Idaho should try to communicate.

The argument that voluntary services cannot possibly be deployed to support the Medicaid population is not substantiated by the fact that already in this country 35 million people are providing services to 55 million seniors at an estimated unreconciled savings to society of $550 billion/year—about what government pays for Medicaid today.

The article from today’s WSJ supports the argument that we have been trying to make over the past 8 years—that Medicaid expansion actually hurts sick patients. Remember that traditional Medicaid was designed to take care of children, pregnant Mothers and those with disabilities. Children less than 6 years of age living at below the 145%FPL, Children 6-18 living below 133% FPL, Pregnant Mothers living below 133% FPL, CHIPS covers children less than 18 living below 186% FPL and Those with disabilities living below FPL

Prior to the ACA, there were 47million people in our country without healthcare insurance. With the ACA we have 27million more covered by Medicaid 72million covered lives total, and 5million more covered with subsidies on the Exchanges. In fact, Medicaid expansion will decrease the market for subsidized insurance—in our State by 20,000 people.

Insurance carriers are seeing an opportunity to make ever-increasing margins and profits in the Medicaid marketplace by using 270 managed care organizations (MCOs) and capitated rates—a flat monthly rate per enrollee. Unlike the exchange products insurance companies are allowed to adjust for the risk of taking care of sick patients when covering sicker Medicaid patients the problem with this model is the cost of future care of capitated patients reported by the MCOs. They are incentivized to overestimate their costs and in fact do so by a process called “over coding”—documented in numerous medical financial articles. This lack of accountability by the State Medicaid programs was noted in a May GAO report that noted the incentive to insurance carriers who in 13/16 States were unable to identify the magnitude of overpayments to MCOS!

Another study of Michigan’s Medicaid program showed the spread between premiums paid and payouts to providers more than doubled between 2013 and 2016—both carriers and providers making out big. In 2016 the DHHS issued a regulation requiring MCOs to pay 85% of premiums on claims, but the unintended consequence of this rule was to encourage insurers and MCOS to “up code” and inflate Medical claims.

So remember with traditional Medicaid, States paid a higher percentage of the costs—Idaho the Feds paid 73%. When it comes to able-bodied patients in the expansion population the Feds pay almost 100%—soon to be 90% of the tab—”so the States are profligate.”

In the end insurance companies are being incentivized to spend more money on patients who are not sick and less money on those patients who are and who may have chronic diseases and illnesses that preclude them from being able to take care of themselves. Let’s take care of those patients and stop subsidizing multimillion-dollar health care systems and networks and large insurance carriers.

Medicaid Expansion as purposed hurts sick patients and their families. Medicaid Expansion as purposed only subsidizes large hospital systems and insurance carriers that currently report billions of dollars of revenues with huge margins.

Idahoans want to help their families and friends who through no fault of their own cannot care for themselves, but they also understand that with the investment of their tax dollars comes the expectation of accountability and responsibility.

  • Costs before coverage,
  • Coverage does not equal access.
  • Access is not quality.

There is a better Idaho way.

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