Dylan Scott at Vox last week had a great piece on Medicaid changes in the Senate bill that are not getting headline attention. I want to pay attention to retroactive eligibility:
2) Retroactive eligibility
The Senate bill also repeals what’s known as retroactive eligibility — a wonky but important provision for new Medicaid enrollees.
Under the current program, when people sign up for Medicaid, they can get their medical care from the three previous months covered retroactively. That’s an important benefit, as many people don’t sign up for Medicaid until they have a medical incident and start racking up bills.
Under the Senate plan, that coverage would be scaled back to the same calendar month that a person enrolled in Medicaid. The new enrollee would be on the hook for any costs accrued before that.
Most people who are eligible for Medicaid but are not signed up for Medicaid don’t have a lot of income nor assets. That is a safe assumption as Medicaid is almost always income limited and often asset limited for eligibility. Since these individuals often don’t have insurance, they are not using medical services if they can avoid it. Some of that avoidance is just toughing a rough spot out or icing and elevating a busted ankle every day after work. Some of that avoidance is counterproductive over the long run such as not being able to effectively manage long term chronic conditions.
A common scenario for retroactive eligiblity to matter is that someone without coverage but with Medicaid eligibility has an event that triggers an emergency room visit that leads to an inpatient admission. At that point the hospital and the doctors know that they are highly unlikely to get a large cash payment from the patient so they see if the person is eligible for Medicaid. Eligibility is either determined or presumed to be determined (presumptive eligibility is another story) and the hospital and the doctors get paid a sum that is significantly more than the cash value of payments that they could squeeze out of the individual who has little income nor assets. Furthermore, the patient now has a way to access appropriate follow-up care.
I’m looking at this purely from a financial perspective as retroactive payments are a direct substitute for provider bad debt. If retroactive eligibility is dramatically minimized as it will be in the Senate bill, we should expect a significant increase in hospital bad debt in areas with large populations of potential Medicaid woodworkers. This will worsen hospital financial situations.
OzarkHillbilly
Mission accomplished.
ArchTeryx
They want to destroy the entire health care system except for concierge care for the rich. They’re going to find out the hard way that the rich are too few in number to simply create an entire Elysium-style healthcare system of their own.
Even the Saudi royal family, going to the Cleveland Clinic for their care, depends on a bunch of peasants to actually keep the CC’s doors open.
RepubAnon
Sounds like a tax increase on hospitals to me. Republican follow-up: allow hospitals to deny coverage to the uninsured. Watching people starving and dying in the streets makes Republicans’ hearts sing.
Soprano2
It seems there is literally nothing in this bill that makes things better for anyone other than the wealthy. Even those cheaper policies will be crap, and will cover almost nothing, so that when someone who has one needs to make a claim they’ll find out they’ve been wasting their money on crap. It’s too bad Republicans care more about fulfilling their stupid promise to repeal the ACA rather than making the health care system work better for people. They would have been so far ahead had they simply promised to make the system better; they’re so hung up on “repeal” that they can’t do anything good for the American people.
Also, I am so frustrated at the continuing rhetoric about “lowering premiums”. It’s like the car salesman who keeps talking about the size of your payment so you don’t notice the outrageous cost of the car! I also wish the press could get the nomenclature right – I keep hearing reporters talk about “health care” when they’re actually talking about “health insurance”. I don’t expect the average person to get this right all the time, but I do expect reporters to talk about it correctly. I heard a story yesterday on “Morning Edition” where the reporter kept making this mistake.
I think it’s telling that none of them are talking about the actual cost of care – it’s all about people’s insurance premiums, and taking benefits away from the “undeserving poor”.
dr. bloor
Can anyone tell me where I can buy up GoFundMe futures?
Another Scott
@dr. bloor: rofl.
You got me curious, though. Looks like a bunch of vulture capitalists bought GoFundMe in 2015. Figures.
Cheers,
Scott.
japa21
@Soprano2: Unfortunately, a lot of people equate cost of premiums with cost of care. This is, obviously, stupid and dangerous.
rikyrah
@ArchTeryx:
YEP
OzarkHillbilly
@japa21: For most people, it’s short hand for “cost of care”. They know there is more involved but that is where it all begins. The GOP is taking advantage of that fact and keep harping on it. The press dutifully reports it as stated. The GOP also constantly say that the way to restrain healthcare spending is to get the consuming public to pay more for their healthcare so they will consume less.
Why elected DEMs don’t harp on this with every other sentence frustrates the hell out of me. It is their job.
TenguPhule
Feature, not a bug.
Then the Churches can snap up the hospitals in debt for a song and start punishing the slutty sluts like their god intended.
Texasdoc
This will also kill people. I’m an oncologist. There are some cancers that grow so fast that waiting to start treatment more than the amount of time it takes to make the diagnosis is an effective death sentence. Right now, my hospital will let me give initial treatment in those cases if it is clear the patient will be eligible for Medicaid, because they know they will be reimbursed to some extent (at least the cost of the drugs, which are expensive). If that changes, the hospital will simply deny permission for chemotherapy. If this bill or anything similar to it passes, there will be blood on the hands of the legislators who vote for it.
kimp
I had eclampsia. in a coma for 4 days. My son weighed 1 lb, 15 oz. St Louis Childrens Hospital cared for him for 3 months in the NICU. Retroactive Medicare was essential. The bills involved in this could not have been paid in my lifetime.