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NPA’s Second Live Twitter Chat: How Best to Fix Medicaid?

Posted by Mark Ryan, MD July 26, 2011 at 12:53 AM

The 46th anniversary of Medicare and Medicaid is July 30th.  Despite the benefits these programs have provided, both find themselves under significant strains due to increasing costs of care, inadequate funding, and political agendas.  Major changes have been proposed to each program–changes that would significantly impact the nature of the Medicare and Medicaid programs, and potentially reverse these programs’ benefits.

Tonight, at 9 pm Eastern, NPA will participate in our second live Twitter chat.  This will be a follow-up to last week’s discussion of Medicare.  The transcript from that chat is available here for your review.

Medicaid provides much of the health care coverage for America’s children (pdf link), especially those from low-income families.  At the same time, Medicaid coverage provides access to heath care for low-income adults, and pays much of the cost of long-term care.  Currently, Medicaid is a target for reform as part of the current budget negotiations in Washington, DC.  As described here, one such reform proposal would change Medicaid to a federal block grant program and would repeal parts of the Patient Protection and Affordable Care Act (PPACA) that require states to maintain current Medicaid eligibility standards.  Under the cover of allowing states to adjust Medicare practices and innovate new models of care, plans such as the State Flexibility Act risk giving states more leeway to drop individuals from Medicaid and/or make the qualification standards harder to meet.  Current negotiations to raise the debt ceiling, such as the “Gang of Six” are also targeting Medicare as part of their proposed cuts to health care benefits.

These proposed reforms are despite the fact that a recent, natural “randomized, controlled” experiment of the effects of Medicaid coverage in Oregon shows multiple benefits among adults receiving coverage.  In this natural experiment, Oregon was forced to randomize individuals on the state’s Medicaid waiting list into those who would be able to apply for Medicaid and those who would not be able to.  This randomization was done by lottery, and resulted from the increased need for Medicaid coverage.  This study showed some interesting results:

  • Medicaid coverage increased the use of medical services, including primary care, prescription medications, hospitalizations, and preventive services.  More consistent primary care accounted for a large portion of the increased use of medical services.
  • Medicaid improved recipients’ financial security: fewer patients had to borrow money or skip payments on other bills, and fewer bills were sent to collections.
  • Medicaid increased patients’ self-reported health status.

Beyond these benefits to adults covered under Medicaid, the program is a key part of providing healthcare for children.  As discussed in this post, Medicaid covers nearly 1/3 of all children in America and does so with remarkable efficiency.  Reducing funding to Medicaid and/or dropping coverage for children could result in many children going without necessary preventive care and vaccinations.  In the long run, these deficiencies in care could result in much higher costs than we can currently imagine.

Tonight, during the Twitter chat, we will focus on the following questions:

  1. Has Medicaid proven its value?  Is it a good program?  What do you see as its current weaknesses?
  2. What do you think about the Oregon study noted above?  Is increased resource utilization a good thing?  Should Medicaid eligibility be expanded, as in the PPACA, or should it be reduced as would be allowed by the State Flexibility Act?
  3. If Medicaid funding is cut, how should those cuts affect coverage for children?  What would be alternative coverage options for children if they lose Medicaid coverage?
  4. What reform options are available for Medicaid?  Would models of coverage such as community health center/academic health center partnerships be an answer?  What about Medicaid-based patient-centered medical homes?

Please join us in this important conversation.  You can follow the chat at www.TweetChat.com/room/MDChat (even without a Twitter account), or if you have a Twitter account you can log in and join the conversation.

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