The New York Times has a good article on the difference in lived experiences of the ACA in New Hampshire. The short version is that people who make more than 400% Federal Poverty Level (FPL) are screwed for a wide variety of reasons. The subsidy cut-off means these folks bear the full cost of premiums and thus the full cost of sabotage.
I want to focus on a secondary line though. New Hampshire uses the Arkansas Private Option model for their Medicaid expansion:
Instead of giving its new Medicaid recipients traditional coverage through the program, New Hampshire uses Medicaid funds to buy them private plans through the Obamacare marketplace. The report, by an independent actuarial firm, found that average medical costs for the state’s expansion population were 26 percent higher than for the marketplace’s other customers in 2016.
The firm found this raised average claim costs — a proxy for premiums — for everyone by 14 percent.
There are two drivers that could lead to higher utilization for the Medicaid Expansion population are the population is sicker than the rest of the Exchange eligible population and the lower cost sharing leads to more services for a given level of health. It is most likely a combination of the two.
New Hampshire could significantly lower costs to non-subsidized buyers by shifting the Medicaid Expansion population to Medicaid Managed Care. This would lead to a significant drop in state expenses as New Hampshire Medicaid pays providers 60% of the standard Medicare rates. Medicare rates are often significantly less than commercial and Exchange rates. This will become increasingly important as the states begin to pick up more of the tab for Medicaid Expansion.
It seems like the Private Option in New Hampshire costs everyone except the hospitals and the docs more money than a straight up expansion.
The costs of the Arkansas/New Hampshire Private OptionPost + Comments (12)