Comments on: Expanding Coverage for Low-income Americans: Medicaid Or Health Insurance Exchanges? http://healthaffairs.org/blog/2009/06/23/expanding-coverage-for-low-income-americans-medicaid-of-health-insurance-exchanges/ The Policy Journal of the Health Sphere Fri, 20 Nov 2009 20:04:42 -0500 hourly 1 By: Health Care. (united health care, universal health care) » Blog Archive » Medicaid: Uniquely Prepared To Deliver On Health Care Reform http://healthaffairs.org/blog/2009/06/23/expanding-coverage-for-low-income-americans-medicaid-of-health-insurance-exchanges/comment-page-1/#comment-27667 Health Care. (united health care, universal health care) » Blog Archive » Medicaid: Uniquely Prepared To Deliver On Health Care Reform Sun, 12 Jul 2009 08:32:41 +0000 http://healthaffairs.org/blog/?p=1450#comment-27667 [...] subsidies to purchase private coverage through a newly-created health insurance exchange.  In his June 23 contribution to this blog, Leighton Ku provides part of the answer, as he demonstrates that a Medicaid expansion is less expensive (both [...] [...] subsidies to purchase private coverage through a newly-created health insurance exchange.  In his June 23 contribution to this blog, Leighton Ku provides part of the answer, as he demonstrates that a Medicaid expansion is less expensive (both [...]

]]> By: David Witt http://healthaffairs.org/blog/2009/06/23/expanding-coverage-for-low-income-americans-medicaid-of-health-insurance-exchanges/comment-page-1/#comment-26288 David Witt Thu, 02 Jul 2009 19:33:00 +0000 http://healthaffairs.org/blog/?p=1450#comment-26288 With regard to using Medicare as the vehicle for adding another 50 million uninsured, there are at least three considerations that must be dealt with. The first is mandates. The 50 states have 50 different levels of state mandated services ranging from 11 to 59. The federal law only specifies 2 mandates. If Medicare was to compete openly for subscribers, many states would have private plans completely eliminated. Texas for example has 59 mandates that add 100% to the cost of private plans whereas Medicare only has two. By law private plans would cost twice as much as a Medicare based plan competing for the same subscriber. Second, Medicare does not deal with medical necessity or value. No pre-approval for procedures; so, while prices are lower, waste is not controlled. Yes, administrative costs are low, but at what cost? The third issue, true with most any solution, is the new subscriber phenomenon. A person that has not had insurance for several years will be a very heavy user for their first year on a new plan. This must be budgeted for in any plan to insure the uninsured and medical necessity control (issue 2) should figure prominently in this budget. With regard to using Medicare as the vehicle for adding another 50 million uninsured, there are at least three considerations that must be dealt with. The first is mandates. The 50 states have 50 different levels of state mandated services ranging from 11 to 59. The federal law only specifies 2 mandates. If Medicare was to compete openly for subscribers, many states would have private plans completely eliminated. Texas for example has 59 mandates that add 100% to the cost of private plans whereas Medicare only has two. By law private plans would cost twice as much as a Medicare based plan competing for the same subscriber.

Second, Medicare does not deal with medical necessity or value. No pre-approval for procedures; so, while prices are lower, waste is not controlled. Yes, administrative costs are low, but at what cost? The third issue, true with most any solution, is the new subscriber phenomenon. A person that has not had insurance for several years will be a very heavy user for their first year on a new plan. This must be budgeted for in any plan to insure the uninsured and medical necessity control (issue 2) should figure prominently in this budget.

]]> By: Tom Watson: Comment of the Week:…. Health Affairs Blog…. | Total Info http://healthaffairs.org/blog/2009/06/23/expanding-coverage-for-low-income-americans-medicaid-of-health-insurance-exchanges/comment-page-1/#comment-26183 Tom Watson: Comment of the Week:…. Health Affairs Blog…. | Total Info Thu, 25 Jun 2009 16:29:32 +0000 http://healthaffairs.org/blog/?p=1450#comment-26183 [...] Currently, the median income eligibility level for parents in Medicaid iRead more at http://healthaffairs.org/blog/2009/06/23/expanding-coverage-for-low-income-americans-medicaid-of-hea... [...] [...] Currently, the median income eligibility level for parents in Medicaid iRead more at http://healthaffairs.org/blog/2009/06/23/expanding-coverage-for-low-income-americans-medicaid-of-hea... [...]

]]> By: Neil Gardner http://healthaffairs.org/blog/2009/06/23/expanding-coverage-for-low-income-americans-medicaid-of-health-insurance-exchanges/comment-page-1/#comment-26148 Neil Gardner Tue, 23 Jun 2009 17:31:01 +0000 http://healthaffairs.org/blog/?p=1450#comment-26148 I have been involved with dental public health since about 1971. I have heard over and over that by increasing reimbursement, many more private dentists will take Medicaid dental kids, and this will increase access potential. It has been almost 40 years and still nothing major in the way of changes has happened in most of the country. The author says that increases in reimbursement would be only a small part of the program, but history suggests that it is still tough to bring about. Either that or there is something else at work in this access area dilemma. I have been involved with dental public health since about 1971. I have heard over and over that by increasing reimbursement, many more private dentists will take Medicaid dental kids, and this will increase access potential. It has been almost 40 years and still nothing major in the way of changes has happened in most of the country. The author says that increases in reimbursement would be only a small part of the program, but history suggests that it is still tough to bring about. Either that or there is something else at work in this access area dilemma.

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