Who would be affected by the end of Medicaid?
After ten years, more than 300,000 children would lose comprehensive coverage through Medicaid and CHIP, as would more than 250,000 adults covered through the ACA Medicaid expansion. Some pregnant women, low-income parents in non-expansion states, and people receiving family planning services through Medicaid would also lose coverage.
Is Medicare still facing a financial shortfall?
The report projects that, based on current law, Medicare still faces a substantial financial shortfall that will need to be addressed legislatively and recommends that this situation be resolved soon to minimize the impact on beneficiaries, providers, and taxpayers.
What happened to Medicaid expansion enrollment in FY 2019?
FY 2019 was the first year in which expansion enrollment declined from the previous year since expansion’s implementation in 2014. Spending on the expansion group represented 16% of all Medicaid spending in FY 2019 and was primarily federal funds.
What are the harmful changes to Medicaid under the Trump administration?
Trump Administration’s Harmful Changes t... President Trump has made clear that his goal remains to repeal the Affordable Care Act (ACA), including its expansion of Medicaid to low-income adults, and to impose rigid caps on the federal government’s Medicaid spending.
How many times has ACA been challenged?
Supreme Court Cases Challenging the ACA. Since 2010, various states, private entities and individuals have challenged parts or all of the ACA nearly 2,000 times in state and federal courts.
What changes have been made to the Affordable Care Act?
ACA permitted states to expand their Medicaid programs. Specifically, states could expand Medicaid to include all low-income adults. In addition, through the ACA Medicaid expansion, the income threshold was increased, increasing the number of people eligible for Medicaid via the ACA.
What are the issues with the Affordable Care Act?
The Problem: Affordability The ACA set standards for “affordability,” but millions remain uninsured or underinsured due to high costs, even with subsidies potentially available. High deductibles and increases in consumer cost sharing have chipped away at the affordability of ACA-compliant plans.
Was the Affordable Care Act repealed?
The result was in-fighting within the Republican Party. On May 4, 2017, the United States House of Representatives voted to pass the American Health Care Act (and thereby repeal most of the Affordable Care Act) by a narrow margin of 217 to 213, sending the bill to the Senate for deliberation.
Did the Affordable Care Act ACA Obamacare improve or worsen HealthCare in the US?
The ACA is the most consequential and comprehensive health care reform enacted since Medicare. The ACA has gained a net increase in the number of individuals with insurance, primarily through Medicaid expansion. The reduction in costs is an arguable achievement, while quality of care has seemingly not improved.
What changes were made in 2020 according to the Affordable Care Act?
This year's changes include the suspension of the penalty for the individual mandate. While the penalty is now $0, note that it is still illegal to not have health insurance. The affordability percentages have likewise changed as of July 2020. We will go into the affordability requirement under the ACA.
Is Affordable Care Act still in effect 2021?
On June 17, 2021, the U.S. Supreme Court voted 7 to 2 to uphold the ACA in California vs. Texas (also known as Texas v.
Why did the Affordable Care Act fail?
Where is the major failure in the ACA? Simply in being affordable. According to the Kaiser Family Foundation, in 2017, 45 percent of uninsured individuals stated that cost was the primary reason they did not enroll in health care insurance.
What did Obamacare do?
Key Takeaways. It was designed to extend health coverage to millions of uninsured Americans. The act expanded Medicaid eligibility, created a Health Insurance Marketplace, prevented insurance companies from denying coverage due to pre-existing conditions, and required plans to cover a list of essential health benefits.
What is Trumpcare health?
Trumpcare is the name given to President Trump's proposed health care plan, formally called the American Health Care Act (AHCA). Below are some things to know about the proposed health insurance legislation at the time.
Is Trumpcare passed?
The American Health Care Act of 2017 (often shortened to the AHCA or nicknamed Trumpcare) was a bill in the 115th United States Congress. The bill, which was passed by the United States House of Representatives but not by the United States Senate, would have partially repealed the Affordable Care Act (ACA).
Will Supreme Court overturn ACA?
Following the latest Supreme Court ruling, the Affordable care Act seems more solidly entrenched in American law.
What are the issues with Medicaid in 2019?
Important Medicaid issues to watch in 2019 include Medicaid expansion developments amid ongoing litigation about the ACA’s constitutionality as well as Medicaid demonstration waiver activities, including those focused on work requirements and other eligibility restrictions.
Which states have eliminated the sunset date for Medicaid expansion?
Other states to watch include Montana, where a ballot initiative to eliminate the sunset date for the Medicaid expansion failed and the expansion now needs to be extended by the legislature to continue, and Alaska, where the governor-elect has been a critic of the state’s Medicaid expansion program.
How many comments were submitted during the 2018 reauthorization?
More than 210,000 public comments were submitted during the rule’s comment period that closed on December 10, 2018. The administration will now review those comments and decide whether to issue a final rule that could go into effect 60 days after publication. What to Watch:
What is risk based managed care?
Risk-based managed care continues to be the predominant delivery system for Medicaid services, and states are focused on implementing alternative payment models, improving quality within MCOs and developing initiatives to address social determinants of health. In November 2018, CMS proposed some changes to the Medicaid managed care rule regarding network adequacy, beneficiary protections, quality oversight, and rate development and payment; the public comment period closes in mid-January 2019. States are seeking to increase Medicaid access in rural areas through coverage of new benefits including telehealth, e-Consult, telemedicine, and tele-monitoring. Strategies also include funding increases for rural providers, expanded SUD treatment services in rural areas, expanded funding for primary care residency programs, and participation in multi-payer initiatives that promote rural access to care. Prescription drug costs continue to exert pressure on Medicaid spending. Many states are implementing a variety of prescription drug cost containment initiatives, especially initiatives to generate greater rebate revenue and implement new utilization controls. Finally, nearly all states are employing one or more strategies to expand the number of people served in home and community-based settings, and states have initiatives to address long-term services and supports (LTSS) workforce issues. Housing-related supports remain an important part of state LTSS benefits, and states are working to maintain housing-related supports even as Money Follows the Person (MFP) grant funds expire . Congress is considering an extension of the MFP program and also changes to extend provisions in the ACA that require states to apply the Medicaid “spousal impoverishment” rules, which allow married couples to protect a portion of their income and assets should one spouse seek Medicaid coverage for institutional long-term care, to long-term care in community-based settings. Additionally, in November 2018, CMS issued a new State Medicaid Director Letter inviting states to waive the federal IMD payment exclusion for those with primary mental health diagnoses, which could have implications for states’ community integration obligations under the Americans with Disabilities Act and the Supreme Court’s Olmstead decision.
How many states have waivers?
To date, 7 states have waivers with work requirements approved; of these, Arkansas implemented its waiver in 2018, and three states (Indiana, Kentucky, and New Hampshire) are set to do so in 2019. Another 8 states have waivers pending decision with CMS as of early January, 2019.
How many states have Medicaid expansion?
Medicaid expansion was an important issue in the 2018 midterm elections. Following the election , 37 states including the District of Columbia have adopted the ACA’s Medicaid expansion. This count includes Maine, where the new governor signed an executive order to begin implementation of the expansion after the outgoing governor delayed implementation following the passage of a ballot initiative in November 2017, as well as three states (Idaho, Nebraska and Utah) that newly passed the expansion through 2018 ballot initiatives. In Kansas and Wisconsin, incoming governors ran on the issue of Medicaid expansion; however, they will have to work with their legislatures to enact a change. Some states that had long opposed expansion like Mississippi and Georgia may also be exploring expansion options. Other states to watch include Montana, where a ballot initiative to eliminate the sunset date for the Medicaid expansion failed and the expansion now needs to be extended by the legislature to continue, and Alaska, where the governor-elect has been a critic of the state’s Medicaid expansion program. Many studies on the effects of the ACA Medicaid expansion point to positive effects on coverage, access to care, service utilization, and state budgets and economies. As states consider Medicaid expansion, a federal trial court judge in Texas v. U.S. ruled that the entire Affordable Care Act (ACA) is unconstitutional on December 14, 2018, although the decision has been stayed pending appeal. While the trial court’s ruling will not be the last word on the ACA’s constitutionality, as appeals have been filed, the litigation could have implications for states considering expansion.
What is Medicaid coverage?
Medicaid, the provider of health insurance coverage for about one in five Americans and the largest payer for long-term care services in the community and nursing homes, continues to be a key part of health policy debates at the federal and state level. Important Medicaid issues to watch in 2019 include Medicaid expansion developments amid ongoing ...
How did the HI trust fund get weakened?
Actions already taken by the Administration and Congress in 2017 and 2018 have also weakened the HI trust fund. By cutting tax rates, the 2017 tax law reduced income taxes on Social Security benefits , part of which go to the trust fund. Repealing the tax penalty for failing to get health insurance (also part of the tax law) will increase the number of uninsured and increase Medicare payments for uncompensated care. The Bipartisan Budget Act of 2018, meanwhile, repealed the Independent Payment Advisory Board, an important tool for slowing Medicare’s cost growth.
What is Trump's plan for Medicare?
President Trump billed a recent executive order as “protecting and improving Medicare for our nation’s seniors” and “enhancing [Medicare’s] fiscal sustainability ,” but it would actually do the opposite. [1] Although many of its proposed changes are vague, and most would require changes in laws or regulations, the order would weaken Medicare and its financing. It would promote private Medicare Advantage (MA) plans, which are prone to overpayments, over traditional Medicare. It could also raise costs for some or all beneficiaries by increasing payment rates to providers; moving toward Medicare premium support, which would likely increase premiums for traditional Medicare; removing limitations on private contracts between patients and providers, thus allowing higher charges for Medicare-covered services; and making it easier for seniors to opt out of Medicare, likely leaving behind a lower-income, sicker patient pool.
What does the HHS executive order do?
The executive order directs the HHS Secretary to “identify and remove unnecessary barriers to private contracts” — a step that would increase costs for beneficiaries or the Medicare program by making it easier for physicians to opt out of Medicare and allowing them to charge more for Medicare-covered services.
Can seniors opt out of Medicare?
Another portion of the executive order would allow seniors to opt out of the HI portion of Medicare (Part A) without giving up their Social Security benefit, thereby threatening the universality of the program, which is vital to preserving its solvency and popularity.
Will Medicare cut low income?
The Trump Administration is considering a change to the federal poverty line that would cut benefits for low-income Medicare beneficiaries. The Office of Management and Budget has requested comments on updating the Census Bureau’s poverty thresholds using an alternative, lower measure of inflation than the traditional Consumer Price Index. That change would lower the poverty line by growing amounts each year relative to the current approach. It would ultimately cause hundreds of thousands to lose access to the Medicare Part D Low-Income Subsidy, which helps them afford prescription drugs. Hundreds of thousands of seniors and persons with disabilities would also lose help paying their Medicare Part B premiums and cost sharing. [12]
How much will Medicaid cut in 2026?
According to newanalysis from the AARP Public Policy Institute, states may cut Medicaid HCBS by as much as $46 billion in 2026 to stay within their allotted per capita caps-- a 22 percent cut. Read the new Insight on the Issues to learn more and find out the potential impact on your state. Read.
How much does social isolation affect Medicare?
Now a new study—the first to examine whether social isolation also affects health care spending among older adults—finds that a lack of social contacts among older adults is associated with an estimated $6.7 billion in additional Medicare spending annually.
What is the Urban Institute report on Medicare?
The Urban report offers important insights into how transforming Medicare to a “premium support” system would work in practice—and how it would adversely affect people with Medicare. The report— Restructuring Medicare: The False Promise of Premium Support by Robert A. Berenson, Laura Skopec, and Stephen Zuckerman— was funded by the AARP Public Policy Institute. Read
What is Medicaid for children?
Medicaid is a lifeline for millions of children, adults with low incomes, individuals with disabilities and older adults who depend on Medicaid for health care services and assistance with long-term services and supports (LTSS) such as eating, bathing, and dressing.
What age group is considered to be in the non-group insurance market?
This series of reports looks at older adults ages 50 to 64 in the nongroup (individual) health insurance market, for whom high health care costs and affordability of health coverage are growing concerns. Read
How much can an older person be charged for health insurance?
The Affordable Care Act (ACA) established a 3-to-1 limit on age rating of health insurance premiums, meaning that older adults who purchase coverage on their own cannot be charged more than three times the amount a younger person is charged for the same health plan. Read
How many older people are uninsured under the ACA?
Did you know that over 3 million older adults ages 50-64 rely on Affordable Care Act (ACA) tax credits to purchase health coverage? In fact, pre-ACA, almost half of them were uninsured.
When will DHS reject Medicaid?
Beginning February 24, 2020, DHS immigration officials will be able to reject immigration applicants if they have received, or are judged likely to receive in the future, any of an array of benefits, including Medicaid. Timing for the DoS implementation of the policy has not yet been announced.
How many children would lose Medicaid in 10 years?
After ten years, more than 300,000 children would lose comprehensive coverage ...
How does a block grant waiver affect health insurance?
States with block grant waivers could deny coverage for prescription drugs, allow states to impose higher copayments on people in poverty , and waive standards for managed care plans (which many states use to provide Medicaid coverage).
How many people in Arkansas lost medicaid in 2018?
In Arkansas, over 18,000 Medicaid beneficiaries — almost 1 in 4 subject to the new rules — lost coverage in 2018 as a result.
What is a block grant waiver?
Inviting State “Block Grant” Waivers. The Trump Administration issued guidance in January 2020 inviting states to seek demonstration projects — known as waivers — that would radically overhaul Medicaid coverage for adults. Under the guidance, states could apply for waivers that would convert their Medicaid programs for adults into a form ...
What is Trump's goal with Medicaid?
President Trump has made clear that his goal remains to repeal the Affordable Care Act (ACA), including its expansion of Medicaid to low-income adults, and to impose rigid caps on the federal government’s Medicaid spending. While Congress considered and rejected a series ...
What would happen if the poverty line was lowered?
By lowering the poverty line, that proposal would ultimately cut billions of dollars from federal health programs and cause millions of people to lose their eligibility for, or receive less help from, these programs. Many programs, including Medicaid and CHIP, use the poverty line to determine eligibility and benefits, and the cuts to these programs — and the numbers of people losing assistance altogether or receiving less help — would increase with each passing year. After ten years, more than 300,000 children would lose comprehensive coverage through Medicaid and CHIP, as would more than 250,000 adults covered through the ACA Medicaid expansion. Some pregnant women, low-income parents in non-expansion states, and people receiving family planning services through Medicaid would also lose coverage.
When will Medicare split the conversion factor?
Under MACRA, Medicare will once again split the conversion factor beginning in 2026. This time, however, payment rates will vary based not on specialty, but on payment model. Physicians who remain in traditional fee-for-service payment arrangements will be paid less for services they provide than physicians who participate in payment models known ...
What factors go into determining Medicare physician compensation?
A number of factors go into determining overall Medicare physician compensation, such as the number of RVUs assigned to a given service; however, without an overall realistic update in place, payments will continue to lose ground to inflation.
What penalties did MACRA eliminate?
In addition, MACRA eliminated penalties associated with prior Medicare quality programs, such as the Physician Quality Reporting System (PQRS), the EHR Incentive Program, and the Value-based Payment Modifier.
How is Medicare reimbursement calculated?
For a given service or bundle of services, the relative value units (RVUs) assigned to that service are multiplied by a dollar amount referred to as the conversion factor.
What factors affect physician payment?
Another factor that could affect physician payment is potential changes to office/outpatient E/M codes. In the calendar year (CY) 2019 Medicare Physician Fee Schedule (MPFS) final rule, CMS set forth a policy that would have combined levels 2–4 new E/M codes, and paid physicians at a blended rate of the previous E/M code levels starting in CY 2021. But in the CY 2020 MPFS proposed rule, CMS proposed a dramatically different change to E/Ms that would instead maintain the separate levels, but increase the values of E/Ms, again starting in CY 2021. Unfortunately, this current proposal will not apply the increased E/M values to the E/M values incorporated into global codes. At this time there is great uncertainty regarding how CMS will move forward, but there is a strong likelihood that potential increased payments for E/Ms will shift payment from surgery to primary care, given budget neutrality requirements for physician payment.
When does Medicare 0 percent expire?
Medicare payment rates are about to enter a six-year period of 0 percent updates, during which early MACRA incentives also are set to expire, meaning many physicians will be faced with lower payment rates based on factors out of their control, not on the quality of care they are providing.
When did Medicare release its annual report?
In April 2019 , Medicare released its 2019 Annual Report of the Boards of Trustees of the Federal Hospital Insurance (HI) and Federal Supplementary Medical Insurance Trust Funds, which analyzed the long-term solvency of Medicare and how depletion of the HI trust fund could affect physician reimbursement over time.
What is the federal Medicaid share?
The Federal share of all Medicaid expenditures is estimated to have been 63 percent in 2018. State Medicaid expenditures are estimated to have decreased 0.1 percent to $229.6 billion. From 2018 to 2027, expenditures are projected to increase at an average annual rate of 5.3 percent and to reach $1,007.9 billion by 2027.
What percentage of Medicaid beneficiaries are obese?
38% of Medicaid and CHIP beneficiaries were obese (BMI 30 or higher), compared with 48% on Medicare, 29% on private insurance and 32% who were uninsured. 28% of Medicaid and CHIP beneficiaries were current smokers compared with 30% on Medicare, 11% on private insurance and 25% who were uninsured.
What percentage of births were covered by Medicaid in 2018?
Other key facts. Medicaid Covered Births: Medicaid was the source of payment for 42.3% of all 2018 births.[12] Long term support services: Medicaid is the primary payer for long-term services and supports.
How much of Medicaid spending was in 2019?
Spending on the expansion group represented 16% of all Medicaid spending in FY 2019 and was primarily federal funds.
How many people are covered by Medicaid in 2019?
In total, Medicaid enrollment for FY 2019 was 75.2 million individuals across all 50 states and DC, with 15.3 million adults enrolled in the expansion group. Within the expansion group, most (81%, 12.5 million) were newly eligible enrollees covered through Medicaid expansion, while a smaller share (19%, 2.9 million) were not newly eligible enrollees (childless adults who were enrolled through state waivers prior to passage of the ACA). The majority of Medicaid enrollment overall (80%, 59.8 million) was within the traditional Medicaid group, which is composed of several different eligibility groups (see Box 1 above for more information). These groups are subject to varying eligibility levels across states, with children and pregnant women generally covered at much higher eligibility levels compared to non-expansion parents and seniors and people with disabilities.
How much did Medicaid spend on expansion states?
Spending on the traditional Medicaid population was much higher: $347.6 billion in expansion states (79% of total spending) and $500.8 billion across all states (84% of total spending). This difference in spending is partially explained by the greater number of traditional enrollees compared to expansion enrollees.
How much is Medicaid for 2020?
In states that have implemented the Medicaid expansion (which was made effectively optional by the Supreme Court ruling on the ACA’s constitutionality ), nearly all adults under age 65 and with incomes at or below 138% of the FPL ($17,609 per year for an individual in 2020) are eligible for Medicaid.
What is a traditional Medicaid group?
Further, the traditional Medicaid group is composed of many different eligibility groups, including groups with smaller enrollment levels but higher per-enrollee spending such as seniors and people with disabilities (for more details, see Per Capita Spending section below).
When did Maine expand Medicaid?
Expansion enrollment ranged from a high of 48% of total enrollment in Oregon to a low of 11% in Maine, which implemented Medicaid expansion coverage in the second quarter of FY 2019 (January 2019), although Maine allowed for retroactive enrollment as early as July 2018.
Does the 6.2 FMAP increase apply to Medicaid expansion group?
New expansion group enrollment is likely to compose a large share of increased overall Medicaid enrollment during the pandemic; however, the 6.2 percentage point FMAP increase does not apply to spending for the expansion group. This issue brief analyzes pre-pandemic trends for enrollment in and spending on the expansion group ...