Utah has been a leading conservative state that has actually been trying to engage in constructive healthcare policy for most of this century. Utah did not accept straight up Medicaid expansion, but there has been a variety of efforts to form several different waiver applications to cover the people who make less than 138% Federal Poverty Line. It looks like the governor and the Center for Medicare and Medicaid Services (CMS) have come to an agreement. The state legislature still needs to approve the expansion.
The agreement looks reasonable from both a conservative policy objective point of view, and from a liberal coverage expansion without poor shaming point of view. This is an agreement that we could have seen in fifteen or twenty states after Chief Justice decided to rewrite the law to fuck over poor people if we had a coherent political process of trade-offs. Conservatives get some policy reforms, liberals and moderates get coverage expansion, and the public gets a bit better off. Not a bad deal at all, but it is still unfortunately a rare deal.
There are a couple of major things going on in the proposal. The first is that there are effectively two seperate programs. The first is an expansion and modification of Medicaid for people making under 100% Federal Poverty Line. There will be small ($4 to $8 per service) co-pays for this group that are within normal Medicaid standards. People who make between 50% and 100% FPL will have an inpatient service co-pay as well. But fundamentally, these people will be getting straight up Medicaid expansion.
The other major program being proposed is for healthy people who make between 100% and 138% FPL. Here the proposal hews far closer to the Arkansas premium assistance model (see page 15) and away from traditional Medicaid. People who have insurance offered at work but can not afford it will receive premium assistance to pay for the employer sponsored coverage. People who are not offered coverage at work are subsidized to purchase a cost-sharing Silver Exchange plan with limited cost sharing. 2% of income is expected to pay for health insurance and then the state covers the rest. People who are “medically frail” but make more than 100% FPL are enrolled in traditional Medicaid as a means of keeping the Exchange risk pools healthier. For people buying on the Avenue H exchange, there aer two plan configurations available. The first is a no emergency room co-pay model with slightly higher premiums. The second model has lower premiums but a $50 emergency room co-pay. The goal is to drive down emergency room visits with the co-pay.
People who don’t have coverage at work are in good shape here. They are getting coverage that scores out at 94% to 96% acturial value where standard cost-sharing Silver plans have an acturial value of 94%. This is an improvement over current conditions. The people I would be worried about are the people who work at places which offer Silver level insurance. They can get that policy at an out of pocket premium of 2% of their income, but they will be facing a $2,500 deductible and a $6,500 out of pocket maximum. That is massive underinsurance as the maximum exposure is half of their annual income.
There are a few other minor bells and whistles in the waiver application, but it is fairly straightforward.
This is, in the current political and legal environment, a pretty good deal for all stakeholders who have been involved so far. It should be implemented.
Nancy Brown Supler
Why is there no news about the PACE/ Medicare program? It sounds wonderful! Sort of an Kaiser/Permanente+ Medicare type plan for the elderly… A salvation for those unable to get long-term care … A solution for those who wish to age in place. I have not seen, nor read of any of it’s good or bad points. I’ve seen nothing about this program at all. ??? ?
OzarkHillbilly
This is what happens when every one recognizes that universal health care is a universal good.
Richard Mayhew
@Nancy Brown Supler: Let me look into this and I’ll have something early next week
WayneL
Richard, my girlfriend has not been able to get a gel injection for her knee approved. She thinks it will be approved after the first of the year, when her deductible goes back to zero again. She said she’s never had anything approved by insurance this time of year. Could she be right, or as usual, paranoid?
rikyrah
thanks for keeping us informed.
is there any word about Pennsylvania now that it has a new Governor?
cmorenc
Utah (particularly the Salt Lake City metro area) is a strange hybrid of hard-red on many big-brush national matters and practical nuts-and-bolts progressivism on the smaller scale (social issues dear to the LDS church like abortion or marriage equality excepted). For example, there’s an excellent system of mass transit in the SLC area, and for all its other downsides, has always had a more hospitable communitarian streak than in areas dominated by mainstream Protestant religions. The streak of “I’ve got mine FU” isn’t nearly as virulent there as it is in other places.
BubbaDave
Cynical Bubba wonders how much this is made easier by the facet that Utah is so blindingly white that it’s easy to convince the voters that benefits will be going to hard-working
whitepeople like them instead of those Cadillac-driving blah people.richard mayhew
@WayneL: That is wierd — I would keep on appealing, and probably follow up with the state insurance commissioner or state attorney general’s office as a CC if things keep on getting pushed back to Jan. 1. And if it is magically approved once the deductible resets to 0, I would keep on pushing back to have it paid as if the service was performed on 12/31/14.
richard mayhew
@rikyrah: Healthy PA is enrolling people now. The big talk is that Governor Wolf does not get into office until the end of January so there will be 100,000 or more people with expansion coverage as of 1/1/15. The big question is what is allowable for the new governor to opt out of the 1115 waiver from the Feds and what can Gov. Wolf get away with politically as he is facing a hostile legislature — is switching from a Rube Goldberg-ish but functional medicaid expansion in Healthy PA to straight up Medicaid expansion worth the fight? I don’t know.
Buddy H
I’ve heard rumblings that hearings are being held to explore a possible single-payer system in the state of New York.
Nancy Brown Supler
@Richard Mayhew: Thank you so much. I’ll be looking forward to learning more…something…
Tom
@BubbaDave: amen. I was about to say something similar. Glad you beat me to it.
richard mayhew
@Buddy H: there are hearings, but no majorities in either chamber to push for it. This is probably a 5 to 10 year push for NY State at the very least.
WayneL
Thanks for the reply, Richard. My girlfriend is a Republican, so she probably has paranoia issues as well. lol
We have so many problems in this country. It’s nice that maybe the health insurance problem might slowly get fixed, in the same way elderly poverty has been somewhat relieved. No thanks to my girlfriend’s party, I add. She’s been screwed for years by health insurance companies, but at least now she’s paying a lot less for the privilege.