Most of Iowa’s Medicaid expansion waiver has been approved according to the Washington Post:
the Department of Health and Human Services has just notified Iowa that it is prepared to grant the state a waiver to pursue much of what it has asked for in response to its request for HHS approval to expand Medicaid-funded coverage to low income Iowans on the state’s own terms….
In Iowa, Governor Terry Branstad had declined to opt in to the Medicaid expansion, and he has been asking HHS for a waiver that would allow Iowa to pursue its own reform that would accomplish pretty much the same thing. Iowa’s solution would use federal money to expand coverage to poor Iowans by financing their premiums through the private market. Iowa also wants to charge those people premiums (at a discount if they agree to a health assessment) with the goal of putting the state’s own conservative stamp on the expansion by requiring Iowans to take charge of their health.
HHS just informed Iowa, I’m told, that they are mostly willing to go along with the state’s request, with a caveat. HHS is granting Iowa a waiver to pursue its own program, but without premiums charged on those up to 100 percent of the poverty line. Those between 100-138 percent of the poverty line would pay the premium.
So what will this tell us?
Another 150,000 or so people will get coverage. I’m betting their coverage won’t be effective 1/1/14. More likely the plans will be implemented in the 2nd quarter of 2014 due to implementation hurdles.
We also learn that HHS is quite willing to allow states to get fairly creative in how they go about expanding Medicaid in ways that provides coverage without having to call it a Medicaid expansion.
Finally poor people won’t get screwed. Assuming the Iowa expansion is a push to the Silver out of pocket assistance plans that Arkansas used in their waiver for the people above 100% federal poverty line, and 100% subsidy to those below 100% FPL, people will be getting coverage that clocks in at 96 or 97% acturial value for someone at 137% FPL and 100% for someone at 88% FPL.
As a second order tea leaf, the proposed Pennsylvania expansion waiver which Gov. Corbett has floated but not filed will get serious push back from the Feds. There are two areas of objections. The first would be premiums for people making less than 100% FPL and the second is work search requirements as a general humiliation step for quite a few people who are already working.
Hill Dweller
Another example of Republicans pursuing their ideology instead of the right policy. Medicaid would be much cheaper, and likely give people better coverage. But BIG GOVERNMENT, SHUT UP!
EriktheRed
Just can’t help themselves, I guess…
c u n d gulag
Taking the PPACA Medicaid money is a no-brainer.
And that’s why so many Republican Governor’s and state legislatures have decided to not take the money.
Actually, Sarah “The Whore of Babblin-on” was right about “Government Death Panels.”
But, as usual, in her word-vomit, she wasn’t specific enough – it should have been “Republican-controlled State Government Death Panels.”
Mnemosyne
Work search requirements would work great for my friend’s sister, who has grand mal seizures that are sometimes (but not always) controlled by medication. Even though it’s illegal, she was fired by her last job because she had a seizure on the job, and her seizures are too erratic for her to find another job.
But, hey, she should have to look for work because otherwise she’s just a freeloader.
Hill Dweller
@c u n d gulag: Even the wingnuts taking the money have to turn it into some sort of revenue stream for insurance companies. Why not just expand the existing medicaid program, which controls cost better and provides better coverage?
c u n d gulag
@Hill Dweller:
Because it makes too much sense?
Phil Perspective
@Hill Dweller: Which is funny because the revenue stream(s) are going to the health insurance companies regardless. Most states’ Medicaid are administered already by private companies.
qtip
Sorry for the basic, off-topic question but googling isn’t yielding a clear answer for me…
Do the different metal levels (Bronze, Silver, Gold, Platinum) offer different coverage? I.e. do some of them cover things the others exclude? Or is the difference solely one of premiums, deductibles, copays, out of pocket max…thx.
soonergrunt
@Hill Dweller: Don’t ever forget that they don’t actually want government to work.
Belafon
We need these requirements because I’ve seen someone taking their free medicaid and using it to buy beer and drugs!
Roger Moore
@Hill Dweller:
There are actually some good reasons for putting people onto health plans rather than Medicaid. It means that people who are right around the cutoff for Medicaid don’t get shuffled between the two based on small changes in their income.
Napoleon
Iowa is terrible news. Its the Republicans first step towards gutting Medicaid everywhere. The Obama admin should have not granted that waiver.
Gene108
If you cannot humiliate the poor, what is the point of existence?
Seems like a fair trade off. The successful tolerate the presence of the poor, in return for a little sport.
Belafon
@Napoleon: So, he’s cutting out people who were never on it in the first place. Would that be the gutting you’re talking about?
Also, the first step was the Supreme Court.
Cassidy
Okay, so my plan. If you and your family make at or below poverty, the Necromonger policy is in affect. That will surely inspire them to move up in the world. Problem(s) solved.
elisabeth
The crappy insurance I used to have through work did this. Had to jump through hoops to qualify and a number of us didn’t bother because the savings wasn’t that great, anyway.
Hill Dweller
@Roger Moore:
Republicans want to privatize medicaid. These waivers get them closer to their goal.
Mnemosyne
@elisabeth:
We get about $300 total from the Giant Evil Corporation if our blood pressure is within normal ranges and our BMI is under 27. Plus they do it on-site, and we get a free box lunch. So it’s fairly popular.
basement cat
What is the deal with the health assessments? I understand them on a symbolic level, but does the insurance industry actually take them seriously as a tool to improve care or health outcomes? Is there any research showing that they actually do anything other than shame people for smoking or being overweight?
Mnemosyne
@Hill Dweller:
As Phil Perspective pointed out, that ship has already sailed. Many states’ Medicaid programs are already administered by private companies. Most of the states requesting waivers are doing so because their state programs are already run by private companies.
IowaOldLady
I vaguely remember hearing about this plan on the radio months ago. As I recall, a bipartisan group of legislators came up with it. I was just grateful we were taking the expansion at all. I think the insurance is purchased through the same group plan used for state employees. Can that be right?
jl
Thanks for the concise explanations of the state GOP Kabuki healthcare theater. I guess some the acts are worse than others., And some don’t even try to put on an act.
Bobby Thomson
One Term Tom can’t be gone soon enough.
brendancalling
@EriktheRed: Tom Corbett should be flayed alive, and fed to hungry school children.
jharp
I don’t like it but am willing to give it a try.
We are going through the same thing in Indiana. We can use the money to expand HIP (Healthy Indiana Plan) that uses private insurance. We only get 2/3rds of the money though.
I think at this point in the game it is a good idea to try several different approaches.
elisabeth
@Mnemosyne:
It has been a couple of years now but I remember a couple of dr visits, a very lengthy survey and a couple of other things. And no boxed lunch.
MattR
@qtip:
I am not an expert, but my understanding is that all plans will cover the same treatments, medications, etc and the difference in level has to do with premiums, deductibles and copays (and potentially different networks of doctors). I believe the ACA sets a maximum out of pocket max across all plan levels, but there is no reason that a platinum level plan could not offer a lower max if the insurance company wanted to do so.
Yatsuno
@Mnemosyne: Hey campaign donors don’t reward themselves you know.
(And FYWP)
The Fat Kate Middleton
A brother in law who lives in far northern Iowa just signed up for the best plan available. He’ll be paying $138 a month for a no-deductible plan that lets him use hospitals that are part of the Mayo Clinic, and can choose from 90 doctors (which I would think were all of them in that remote rural area). He and his significant other (who also applied) have been told their plans will kick in 1/1/14. They may find out otherwise, but that’s what they’ve been told. They have had no insurance – ever – until now, and have been terribly worried about losing what little they possess the next time illness or injury happens. They are both so happy about this. BIL told me he thought they’d never be able to have something like this.
Talentless Hack
@Belafon: Or letting the Russian mob milk the system using their accounts. I’ve heard that one too. That one actually happened, but they eventually got caught and the system further reformed as a result.
The Fat Kate Middleton
@MattR: This was my experience when I helped relatives choose their plans.
IowaOldLady
@The Fat Kate Middleton: That’s what they found on the Federal Exchange, right? It’s not Medicaid?
StringOnAStick
@elisabeth: My husband’s company requires this sort of hoop-jumping. My husband is also the fittest, strongest, most athletic person I know, and of all the 7 categories his good cholesterol was too high, thus making his total cholesterol too high (according to their metrics, which science shows are BS but gotta sell those statins).
So, now he has to wear a mini-pedometer to “make up for it” and save us some money each month on our HC premiums. I’d like to see the look on the administrator’s face when they see the data downloaded from his mini-ped; I guarantee you that no one else there is racking up the mileage he does. Though one of his officemates figured out that you can attach the mini-ped to a flyswatter and rack up some miles there too…..
The Fat Kate Middleton
@IowaOldLady: They went to the Iowa Health Benefit Exchange website. I’ll see if I can find and post it. He found out he would receive a $459/mo. subsidy, while his SO had to pay nothing.
eric
@EriktheRed: feature, not bug
The Fat Kate Middleton
@IowaOldLady:
http://www.healthinsurance.org/iowa-state-health-insurance-exchange/
WereBear
I am apprehensive about signing onto those Rewards things.
I have a way through our new work plan to get money towards my deductible, but they have all these boxes to click on regarding My Compliance. I lowered my weight, blood pressure, and A1C blood sugar readings by eating Paleo, but it puts my cholesterol into an area I’m sure they won’t like. (Not that I care.)
If I eat in a way that lowers my total cholesterol, my weight and blood pressure goes up.
So I’ve just avoided the whole thing.
IowaOldLady
@The Fat Kate Middleton: Thanks!
Fake Irishman
FYI: Here’s Arkansas and Iowa’s plans compared in a nutshell.
http://kff.org/health-reform/fact-sheet/medicaid-expansion-through-premium-assistance-arkansas-and-iowas-section-1115-demonstration-waiver-applications-compared/
The Fat Kate Middleton
@Fake Irishman: Interesting. Thanks for this. I’ll have to give it a little more study tomorrow, when I’m a little more rested. Maybe Richard could answer one question I have: this comparison notes that Iowa will provide dental benefits re “a capitated commercial dental plan or carve-out.” What does this mean?
WereBear
@StringOnAStick: Holy crap, that’s exactly the kind of ignorant stupidity I’m afraid of should I sign up for one of those “health rewards” things.
StringOnAStick
@WereBear: Yep, I’m afraid so; it wasn’t exactly optional for us, unless you call a $300/month penalty ‘optional’.
We’re just like you in that we went paleo and had HUGE improvements in the things that matter (BP, triglycerides, A1c, blood glucose, etc.). I am no longer pre-metabolic syndrome or constantly fighting migraines, but we both have total cholesterol levels just over that ‘magic’ 200 level. I feel better than I’ve felt in years, but the outdated/cherry-picked ‘wisdom’ of Ancel Keyes still dominates the medical industry, thanks to the insane profitability of statins to big pharma. Funny how they aren’t so over-prescribed in countries with non-profit health care systems….
Villago Delenda Est
@Belafon:
What’s worse, they then proceeded to use their SNAP to buy t-bones to feed the dog, THEN they paid for the non-SNAP items with Benjamins peeled off a roll of Benjamins!
Villago Delenda Est
@brendancalling:
Look, abusing children like that is a serious offense.
Cassidy
@basement cat: When used properly, health assessments are a good thing. They not only give you baseline numbers, but also a good place to start talking to your patient about lifestyle changes. Preventive medicine is cheaper than treating disease.
Mnemosyne
@Cassidy:
I don’t mind the one at my workplace because it’s optional and offers a cash bonus (or they put the money into your FSA, which means you get the whole amount and don’t have any taxes taken out). The ones that tie your participation to your health insurance costs are much more problematic, IMO.
Cassidy
@Mnemosyne: Yeah. It all depends on what they’re being used for. My employer does one for everyone to make sure we’re all healthy enough to fight fire.
WereBear
@Cassidy: I got no problems with people looking at my BMI & blood pressure. A1C actually is a very important number.
But cholesterol levels? Bunch of BS.
MattR
@Mnemosyne: Our company used to have two different sets of insurance rates based on whether or not you participated in their wellness program. That is now illegal under Obamacare so we have a single rate (with exceptions for smokers of course) and they will give you money in an FSA if you take part in the wellness program. The end result is essentially the same and I don’t find the second to be any more acceptable. IMO, giving everyone else a bonus if they do something is the same as making me pay more for not doing it.
@Cassidy: I can completely understand a company making sure their employees are capable of withstanding the physical rigors of their job, but I dislike the monetary aspect of it. I do understand that many people won’t participate without an incentive, but I think we are crossing a line when our employers start punishing random office workers for not meeting a set of rigid criteria (when it has nothing to do with the employee’s short term ability to do their job).
Mnemosyne
@MattR:
That’s kind of a weird way of looking at it, IMO. Do you get resentful of all bonuses given to other people, or only this one?
MattR
@Mnemosyne: If I make $2000 a month, what is the difference between choosing between insurance plans that cost $200 with a wellness plan or $250 without and paying $250 for any insurance plan but getting a $50 bonus if I participate in the wellness plan? Either way, if I am in the wellness program I have $1800 to spend on other things and if I’m not in the wellness program I have only $1750.
I view participation in a wellness program as very different from earning a bonus based on your performance at your actual job. I don’t resent anyone who does their job well and earns a bonus, but yes I do get a bit resentful when my compensation is based on my lifestyle, my medical condition and the treatment I am choosing (as long as I am still able to do my job at the moment) (EDIT: I should note that my resentment is aimed at the company and not the other employees.)
qtip
@MattR:
Thanks. I think I agree with you, but it is hard to know for sure. The help email address on my state exchange bounces most emails sent to it. The contact form hasn’t yielded a reply. The humans on the phone don’t know…they just kept reading me the specs for the different plans (which actually did have differences: one covered out of country and another did not but I wasn’t sure if that was just a typo in the docs).
MattR
@qtip: Out of country, hmmm? I have no idea about that. When you are getting that information I would check if they are talking about coverage while out of country as a tourist (or on business) as opposed to coverage if you want to go out of country for a procedure because it is cheaper (or quicker) there or if they mean both.
Cassidy
@WereBear: That might not entirely be your employer or insurance. Medicine goes in trends and “med home” is the current trend. Med home has a number of benchmarks that are measured in percentage of patient population and it’s things like “checked a1c or cholesterol within first visit” or “followed up in (blank) days”.
@MattR: I think most corporations are evil, but I do understand the financial bottom line behind their thinking when it comes to employee health. I don’t agree with it, but I can see the twisted logic behind it. The easy answer is to stop punishing people for being sick.