States vote to help kill poor Americans

Medicaid expansion in U.S. states found to cut death rates

By Lewis Krauskopf

Wed Jul 25, 2012 5:21pm EDT

(Reuters) - State expansions of the Medicaid health insurance program for poor Americans reduced adult mortality rates by more than 6 percent compared to states that did not broaden eligibility for their plans, according to a study released on Wednesday.

The findings published in the New England Journal of Medicine could fuel a political furor over new plans for a nationwide expansion of Medicaid that erupted after the U.S. Supreme Court's ruling to uphold President Barack Obama's healthcare law in late June.

In an unexpected move, the high court ruling also left it up to states to decide whether to participate in the law's broader eligibility criteria for Medicaid that would extend insurance coverage to as many as 16 million more Americans starting in 2014. At least five Republican governors who opposed the healthcare law have vowed to opt out of the expansion, saying the program will pose a huge financial burden.

The lead author of the study was Benjamin Sommers, an assistant professor in health policy and economics at the Harvard School of Public Health who is temporarily working as an advisor to the U.S. Department of Health and Human Services. According to a disclosure note in the study, the paper was conceived and drafted while Sommers was employed at Harvard and the findings do not reflect official U.S. government policy.

The study examined three states that substantially broadened Medicaid eligibility for adults since 2000 -- New York, Maine and Arizona. They were compared to neighboring states that did not implement expansions -- Pennsylvania (for New York), New Hampshire (for Maine) and Nevada and New Mexico (for Arizona).

Adults between the ages of 20 and 64 years old were studied for five years before and after the expansion, using data from the U.S. Centers for Disease Control and Prevention.

Medicaid expansions were associated with a reduction in mortality from all causes, by 19.6 deaths per 100,000 adults, for a 6.1 percent decrease compared to the states without expansions.

The mortality declines were greatest among adults between ages 35 and 64, minorities and residents of poor counties.

The expansions also led to decreased rates of uninsurance, lower rates of delayed care because of costs, and an increase in the rate of people reporting their health status as "excellent" or "very good".

"The takeaway is that state expansions of Medicaid coverage to adults appear to be effective at improving both access to care and health for low-income Americans," Sommers said in an interview.

The results corresponded to 2,840 deaths prevented per year in the states with Medicaid expansions. That figure suggests that 176 additional adults would need to be covered by Medicaid in order to prevent one death per year, according to the study.

(Reporting by Lewis Krauskopf; Editing by Michele Gershberg and Carol Bishopric)

13 states aim to limit Medicaid
By Phil Galewitz and Matthew Fleming, Kaiser Health News

Thirteen states are moving to cut Medicaid by reducing benefits, paying health providers less or tightening eligibility, even as the federal government prepares to expand the insurance program for the poor to to as many as 17 million more people.

States routinely trim the program as tough times drive up enrollment and costs. But the latest reductions — which follow more extensive cuts last year — threaten to limit access to care for some of its 60 million recipients.

"With more people on Medicaid, states will have to continue to ratchet down payments and limit services," says Nina Owcharenko, director of the Center for Health Policy Studies at the conservative Heritage Foundation.

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Some worry the cuts to doctors and hospitals could make it more difficult to expand the state-federal program in 2014, as called for by the federal health law. "Some providers may be unwilling to accept new Medicaid patients," former New York Medicaid director Deborah Bachrach says.

But she notes the law may counter that effect with its funding boosts to community health centers and its temporary rate increases for primary care doctors, beginning in January 2013.

Most of the cuts went into effect this month, according to a 50-state survey by Kaiser Health News for USA TODAY. Among them:

•Illinois limited enrollees to four prescriptions a month; imposed a co-pay for prescriptions for non-pregnant adults; raised eligibility to eliminate more than 25,000 adults; and eliminated non-emergency dental care for adults.

•Alabama cut pay for doctors and dentists 10% and eliminated coverage for eyeglasses.

•Florida cut funding to hospitals that treat Medicaid patients by 5.6% — following a 12.5% cut a year ago. The state also seeks to limit non-pregnant adults to two primary-care visits a month, and to cap emergency room coverage at six visits a year.

•California added a $15 fee for those who go to the emergency room for routine care. It cut reimbursements to private hospitals by $150 million and to public hospitals by $41.5 million.

•Wisconsin added or raised monthly premiums for most non-pregnant adults with incomes above $14,856 for an individual.

Colorado, Hawaii, Louisiana, Maine, Maryland, New Hampshire and South Dakota also are making reductions to their programs. Connecticut is weighing cuts likely to go into effect this fall.

A few states have increased Medicaid benefits, including Arizona, which will boost pay for mental health providers next April. And some are looking to restore cuts made during the worst of the recession, says Vernon Smith, managing principal with consulting firm Health Management Associates and a former Michigan Medicaid director.

Stacey Mazer, senior staff associate with the National Association of State Budget Officers, notes that fewer states are cutting the program this year, partly because many are in better economic shape and partly because of reluctance to make further cuts.

"States are hearing a lot of hue and cry about the impact on access," she says.

Last November, for instance, about 3,500 Medicaid recipients in New Hampshire had to find new doctors after cuts led LRGHealthcare in Laconia to stop offering primary care to non-pregnant adults, Senior Vice President Henry Lipman says.

"To see two decades of providing access for our community basically erased has been very disheartening," he says.

It is unclear how many states will participate in the law's Medicaid expansion since the Supreme Court ruled last month that they may not be penalized for opting out. A number of Republican governors have vowed not to participate, citing costs. Although the federal government will pay for the first three years, states will have to cover up to 10% of the costs after that.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a non-profit, non-partisan health policy research and communication organization not affiliated with Kaiser Permanente.

When governments choose providing higher salaries for government workers, choose to support tax cuts for the rich, choose to cut healthcare for the poor, they are in effect killing the poor. Why do we let this happen in America? Do something!