Featured Research

from universities, journals, and other organizations

Middle road for Medicaid expansion?

Date:
April 7, 2014
Source:
University of Michigan Health System
Summary:
With the political divide over health care reform still strong going into this year's elections, a new analysis of state-level decisions shows signs of an emerging middle way toward reducing the ranks of the uninsured. The approach centers on efforts by governors and legislatures to get federal permission to customize Medicaid expansion in ways that satisfy political conservatives -- while still allowing them to collect federal funding to increase health insurance coverage in their state.

With the political divide over health care reform still strong going into this year's elections, a new analysis of state-level decisions shows signs of an emerging middle way toward reducing the ranks of the uninsured.

Related Articles


The approach centers on efforts by governors and legislatures to get federal permission to customize Medicaid expansion in ways that satisfy political conservatives -- while still allowing them to collect federal funding to increase health insurance coverage in their state.

In a new Viewpoint published online by the Journal of the American Medical Association, a team from the University of Michigan assesses the results so far.

They focus on two major Affordable Care Act-related decisions: whether to create a state health insurance exchange, and whether to expand Medicaid eligibility to low-income adults, which comes with full federal funding at first and phases in state contributions over several years. They also look ahead to potential issues that may arise as ACA-related Medicaid waivers granted to certain states hit new milestones.

The team, from the U-M School of Public Health, Medical School and Institute for Healthcare Policy and Innovation, find that only 15 states and the District of Columbia have chosen to fully comply with the ACA as originally designed by creating a state-based exchange and expanding Medicaid. But 23 states took neither of these steps.

Partisan politics plays a role, they find. All but two of the 15 states that started their own exchange and expanded Medicaid are led by Democratic governors, and all but three of the 23 states that did neither are led by Republican governors.

But party control doesn't tell the whole story, they say. In all, 11 states expanded Medicaid and went with the federal or a federal-state partnership exchange, including six led by Republican governors.

One of them, Michigan, just began enrolling residents in its Healthy Michigan Plan on April 1, and initial reports suggest rapid and smooth progress. Idaho is the only state to have said no to Medicaid expansion but created a state exchange.

"This is clearly an important issue because of the coverage gap that will leave nearly 6 million people uninsured who are living below the poverty level or just above it in states that don't expand Medicaid," says Phillip Singer, MHSA, one of two U-M doctoral students who carried out the analysis.

He and his colleagues focused on the waivers that conservative-leaning states have asked the federal government to approve, allowing them to customize the Medicaid program during expansion.

"Each state seems to be pushing a little further to tailor the Medicaid program to fit their political ideology, and we don't know where this is going to end or where the federal government will say a state has gone too far," says Singer, who is working toward a degree in the U-M School of Public Health's Health Services Organization and Policy program.

The team compiled data on the current state of Medicaid expansion and state-level insurance exchanges across the country. Co-author David Jones, MSPH, MA, also conducted interviews over nearly three years with leaders in 25 states as part of his doctoral work in the same program.

Senior author John Ayanian, M.D., MPP, explored the politics of Michigan's Medicaid expansion and its potential as a model for other Republican-governed states in a previous article in the New England Journal of Medicine.

Arkansas and Iowa also sought waivers, and Indiana and Pennsylvania currently have proposed waivers before the federal Department of Health and Human Services, with other states such as Missouri and Utah working toward possibly proposing waivers in order to customize Medicaid.

The waivers states have sought allow or would allow them to include conservative-favored options in expanded Medicaid programs, including cost-sharing, health savings accounts, and financial incentives for healthy behaviors or disincentives for certain health care-related actions -- for example visiting an emergency department for a condition that could have been treated in a primary care clinic.

"These waivers are very important politically, enabling governors to persuade enough conservatives in their legislatures to support a modified Medicaid expansion," says Ayanian, who is the Alice Hamilton Collegiate Professor of Medicine in the Medical School's Department of Internal Medicine. "This approach allows Republicans to pursue Medicaid waivers they view as beneficial for their states without endorsing other components of the ACA." A member of the Division of General Medicine, Ayanian is also a professor in the U-M School of Public Health and the Ford School of Public Policy.

Over the next six years, as waivers begin to expire and states must begin to shoulder part of the expense of people enrolled under expanded Medicaid criteria, the political tides will play a major role in whether states continue to participate, the authors predict.

"Waivers are a way for Republican governors and legislators to say they are reforming Medicaid instead of embracing Obamacare, while still accepting federal money available because of the Affordable Care Act," says Jones. "Hospitals, providers, and small businesses are advocating strongly in favor of Medicaid expansion. But there are many states where any chance of Medicaid expansion will depend on policymakers finding a middle way."

The current state harkens back to the original creation of Medicaid in 1965 -- and the slow process of getting the second half of states to sign on, with Arizona finally joining in 1983. But, the U-M authors say, the federal waiver process gives states much more flexibility than they had when Medicaid was launched.


Story Source:

The above story is based on materials provided by University of Michigan Health System. Note: Materials may be edited for content and length.


Journal Reference:

  1. David K. Jones, Phillip M. Singer, John Z. Ayanian. The Changing Landscape of Medicaid. JAMA, 2014; DOI: 10.1001/jama.2014.3700

Cite This Page:

University of Michigan Health System. "Middle road for Medicaid expansion?." ScienceDaily. ScienceDaily, 7 April 2014. <www.sciencedaily.com/releases/2014/04/140407153937.htm>.
University of Michigan Health System. (2014, April 7). Middle road for Medicaid expansion?. ScienceDaily. Retrieved November 28, 2014 from www.sciencedaily.com/releases/2014/04/140407153937.htm
University of Michigan Health System. "Middle road for Medicaid expansion?." ScienceDaily. www.sciencedaily.com/releases/2014/04/140407153937.htm (accessed November 28, 2014).

Share This


More From ScienceDaily



More Health & Medicine News

Friday, November 28, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Rural India's Low-Cost Sanitary Pad Revolution

Rural India's Low-Cost Sanitary Pad Revolution

AFP (Nov. 28, 2014) One man hopes his invention -– a machine that produces cheap sanitary pads –- will help empower Indian women. Duration: 01:51 Video provided by AFP
Powered by NewsLook.com
Research on Bats Could Help Develop Drugs Against Ebola

Research on Bats Could Help Develop Drugs Against Ebola

AFP (Nov. 28, 2014) In Africa's only biosafety level 4 laboratory, scientists have been carrying out experiments on bats to understand how virus like Ebola are being transmitted, and how some of them resist to it. Duration: 01:18 Video provided by AFP
Powered by NewsLook.com
WHO Says Male Ebola Survivors Should Abstain From Sex

WHO Says Male Ebola Survivors Should Abstain From Sex

Newsy (Nov. 28, 2014) WHO cites four studies that say Ebola can still be detected in semen up to 82 days after the onset of symptoms. Video provided by Newsy
Powered by NewsLook.com
Ebola Leaves Orphans Alone in Sierra Leone

Ebola Leaves Orphans Alone in Sierra Leone

AFP (Nov. 27, 2014) The Ebola epidemic sweeping Sierra Leone is having a profound effect on the country's children, many of whom have been left without any family members to support them. Duration: 01:02 Video provided by AFP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins