Thursday, January 9, 2014

Obamacare, Delaware Medicaid, and the dangers of oversimplifying complex stories

Whether you are a friend or foe of ACA/Obamacare, it is often difficult to keep score about what's happening because the news media (a) breaks up many of the stories into discrete chunks that do not let you "connect the dots"; (b) most coverage is ideologically rather than factually driven anyway; and (c) most people are only reading the stories that comport with what they already want to believe.

Nonetheless, with an attempt at basic integration, here goes.

First:  sign-up continue to be abysmal. Delaware originally predicted that 25,000-30,000 people would find private insurance in the marketplace, and that a similar number would receive coverage under expanded Medicaid.  As of today the numbers are far from projections:  1,145 people have actually gotten plans and paid a premium; 3,183 have signed up for plans but have not finished the process; and 5,732 have become new Medicaid clients.  Only 13% of those who have stepped forward have been younger people.  Not surprisingly, the State has gone mum on statistics about how many people lost their plans or which private insurers are benefitting.  I'll show you why in a second.

Second, on a national level, cancellations are running ahead of enrollments by about 3 million.  Pro-rated for DE this would suggest that about 10-15,000 Delaware citizens have lost their insurance and thus far have not been able to replace it.

Third:  almost all of those Delawareans who lost insurance would have lost Highmark of Delaware BCBS "junk" plans, which they will end up having to replace with Highmark of Delaware Bronze of Silver plans that have high premiums and high deductibles.  If the early stats and Highmark's current monopoly status in the private insurance market holds true, at least 1,000 of those 1,1,45 new policies issued came from Highmark.  Given Highmark's business practices I would almost say that the 25% of Delaware citizens currently on Medicaid should be happy they are not covered by Highmark, except that . . .

Fourth:  your ability to use your Medicaid (if you have it) is becoming increasingly circumscribed.  Thanks to the Highmark/MedExpress 1-2 punch there is pressure on so-called "Medical Aid Units" (urgent care clinics) in Delaware.  The locally owned units except those belonging to Christiana Care, are slowly but inexorably being forced out of the market, selling to larger chains.  The chains coming in (and, one expects, eventually MedExpress) have a general reluctance to take Medicaid.  Case in point:  Dr. Vince Schaller's Hockessin Walk-in, which took anybody and everybody pretty much regardless of their ability to pay, has been forced to sell out to the Premiere chain.  And three months after the transition, guess what?  Premier stopped taking Medicaid.  Look for other MAUs and then doctor's offices to follow.  The Medicaid reductions in payments are forcing medical units out of the Medicaid market.

Fifth:  the State is probably secretly happy that fewer than expected have qualified for expanded Medicaid, as the Feds changed the Fed/State ratio and the Markell administration is now losing another $1,000 per year on each new enrollee.  Probably doesn't sound like a lot until you multiply by 1,000 by 30,000, and then suddenly it's real money.  I'm starting to hear rumors that the Governor is rethinking his commitment to expanded Medicaid, although I don't know how he gets out of it at this point.

Conclusion?  This is a mess.  How do we fix it?  Ah, the $64 million question.


NCSDad said...

Ezra tries to keep it real:

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delacrat said...

"How do we fix it?"

National single-payer/Medicare-for-all

That's the approach every other industrialized country has taken to fix it.

Steven H. Newton said...

Not completely true, Delacrat. Britain's NHS is significantly different than a Medicare for all model, and so are others.

But even if you assume that Medicare for all is the preferred model, here's the roadblock: not one of those countries in Europe or elsewhere had such a gigantic health insurance industry that had been given the opportunity by the Federal government to cut the 50 states up into 50 separate little monopolies. Look at the deal Highmark got to come into Delaware and ask yourself which Democrats are going to forego the campaign contributions to bell the cat.

delacrat said...

"...the campaign contributions...."

Now, THAT is the root of the problem.

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