Fifty years ago this week Medicaid and Medicare were signed into law. These two programs provide children, seniors, people living with disabilities and working families with access to the health care they need. To celebrate 50 years of these two programs, each day this week one of our partners will share a story about their work to ensure more people can access Medicaid. We’ll also be reflecting on the two programs and what’s ahead. 

Hannah is a 27-year-old member of the Confederated Salish and Kootenai Tribes in northwest Montana. She works as a massage therapist and research assistant, and is also a caregiver for her elderly grandmother and quadriplegic cousin. Two years ago, Hannah was diagnosed with Lyme disease and recently her health has declined drastically.

Right now, Hannah is uninsured. She can’t afford health insurance and doesn’t make enough to qualify for tax credits. She’s able to access basic health care through Indian Health Services (IHS), but is unable to get the specialist care she needs to manage her Lyme disease. She had to pay $900 out of pocket for lab work just to get a definitive diagnosis.

“Having expenses for medical care is really hard for my family,” Hannah said. “Medicaid would give me the chance to see a doctor where I live and  live a healthy, normal life.”

Hannah is just one of approximately 20,000 American Indians in Montana who will benefit from closing the coverage gap by expanding access to Medicaid. Montana ranks highest of any state in uninsured American Indians (40 percent) and the second lowest in number of American Indians with private insurance (28 percent). IHS faces an ongoing and severe funding shortage, with federal funding covering only 60 percent of the demand for care. Many American Indians who rely on IHS for care experience a lack of access to specialty care, like Hannah, preventative care, or early treatment for chronic disease. Medicaid plays a very important role in bridging the gap in access to care.

Current Medicaid recipients in Indian Country are able to seek care from IHS-run tribal or urban Indian clinics, as well as other non-tribal health care facilities. In addition to better health outcomes and continuity of care, Medicaid provides an influx of federal dollars that creates an economic boost to IHS and communities in Indian Country. This federal funding can increase the capacity of IHS to meet the health care needs of the community, improve their core services, and update equipment and facilities.

Services provided by IHS to American Indian Medicaid recipients are 100 percent reimbursable by the federal government, and this reimbursement rate will not change when the coverage gap closes. Not only do Medicaid recipients get better access to health care, and not only does IHS receive a much needed influx of funds, but there is no fiscal obligation to the state.

For years, Medicaid has helped to create strong and healthy individuals, families, and communities in Indian Country. As we celebrate Medicaid’s 50th anniversary, we should celebrate the positive impact Medicaid has on reservations and in urban Indian communities, and we should also remember that we have a unique opportunity to continue to improve health care and support communities in Indian Country through Medicaid expansion. For Indian Country, closing the coverage gap is one step toward eradicating generations of extreme health disparities affecting American Indians. Most of all, it is a commitment that will strengthen Montana’s families, communities, and economy.

Sarah Howell, Executive Director, Montana Women Vote

Fifty years ago this week Medicaid and Medicare were signed into law. These two programs provide children, seniors, people living with disabilities and working families with access to the health care they need. To celebrate 50 years of these two programs, each day this week one of our partners will share a story about their work to ensure more people can access Medicaid. We’ll also be reflecting on the two programs and what’s ahead. 

At Voices for Virginia’s Children, we are reflecting on Medicaid’s 50th anniversary and what the program has meant to generations of children and families here in Virginia. 

If children don’t have adequate access to health care – both preventive care and treatment – few of our other goals for them are attainable:

  • Lack of routine well-child visits in young children can mean missing the diagnosis and treatment of developmental delays, which can cause kids to struggle in school.
  • Kids without health care coverage don’t get taken to the doctor when they’re sick; instead, illness can escalate until costly and crisis-oriented emergency care is required.
  • Without health insurance for their kids, parents also miss the age-appropriate guidance from pediatricians or family physicians about developmental milestones to help them provide optimal care for their children.

Nationally, more than 71 million children now access health care because they have coverage through either Medicaid or the Children’s Health Insurance Program (CHIP). In Virginia (you can check your state here), almost one million kids have this coverage, either through Medicaid, for families who earn a little above the poverty line (143 percent of the federal poverty level) and FAMIS (our CHIP program) for families who earn up to twice the federal poverty level. (The federal poverty rate in 2015 is a meager $24,250 for a family of four. 

Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefits for children are “a model for pediatric care.” EPSDT provides comprehensive coverage, including dental, vision and hearing screenings and treatment – recognizing that kids whose teeth hurt or who cannot see or hear the teacher are not going to be able to learn. In fact, research shows that increased enrollment in Medicaid and CHIP not only have a positive effect on child health indicators such as obesity and teen pregnancy, they also have a positive effect on academic achievement.

We celebrate the success of Medicaid because kids are still struggling in poverty at disproportionate rates in this country. In Virginia, almost 300,000 children live below the poverty line—what’s worse, we are one of only 10 states in which the child poverty rate got worse between 2012 and 2013. Kids growing up in poverty are already starting out behind their peers in more economically secure families. Yet for all the ways these kids may have the deck stacked against them from the start, health care doesn’t have to be one of them—and for that we can credit Medicaid.

Just as kids in poverty struggle to succeed in life if they don’t have regular access to health care, their parents do, too. Research shows us that when parents don’t have health insurance, the whole family is at risk.

  • Uninsured parents with chronic illnesses often have to go without needed treatments, making them less able to provide consistent care for their kids.
  • In low-income families, one medical emergency for a parent without insurance can mean financial ruin—making it impossible to meet their kids’ basic needs.
  • Untreated maternal depression can have dire, lifelong consequences on the wellbeing of young children.

Many states have figured out that allowing low-income, uninsured adults – including the 25 percent who are parents of children younger than 18 – to enroll in Medicaid according to the provisions of the Affordable Care Act is a smart investment in our future. Not only will we have a healthier workforce now, we will improve the health and academic trajectory of tomorrow’s workforce. Kids whose parents are insured are more likely to have insurance themselves and be taken to the doctor for routine care.

Unfortunately in Virginia, Medicaid coverage is very restricted for adults in poverty, including parents. Depending on where in the Commonwealth you live, making as little as $7,980 a year could mean you earn too much as a parent in a family of four to qualify for Medicaid.

The great news is that we have an opportunity to improve the situation for low-income families, helping both parents and kids by closing the coverage gap between existing adult Medicaid eligibility levels and eligibility for tax credits in the Marketplace. As child advocates, we are still working with many others to find a Virginia-specific solution to the dilemma of uninsured, low-income adults.

So while we celebrate the generations of kids who have grown up with access to comprehensive health care because of Medicaid, we must also seize the opportunity to improve outcomes for kids and parents in the future through increased Medicaid coverage. 

--Margaret Nimmo Crowe, Executive Director, Voices for Virginia’s Children

The end of Congressional détente?

Things have been relatively quiet in Congress lately and there has even been some bipartisan work getting done, but that could change relatively soon and I am not even talking about the continued parade of ACA repeal votes that are coming down the pike in the Highway bill or via budget reconciliation. Those efforts are getting shrugged off and consigned to the realm of symbolism.  I’m talking about a series of must-do measures that could bring us back to the world of hostage-taking, and government shut-down brinksmanship. Here are three leading flashpoints:

Appropriations: It is now clear that the appropriations process will not be completed on time. That means Congress will have to pass a continuing resolution (CR) in order to avoid a government shut-down. A CR would be easy to pass except that parts of the Republican caucus seem intent on using it to make policy changes, notably to strip all federal funding from Planned Parenthood.

Social Security disability insurance: The SSA Trustees report shows that unless Congress acts, millions of people with disabilities will receive a 19 percent cut in their already meager benefits. Again, an easy fix is available for Congress—they can vote to transfer funding to the SSDI account from the larger retirement trust fund (as Congress has done several times in the past with little fanfare).  However, congressional Republicans are seeking changes in the program as the price for extending its life, setting up what is sure to be a tense negotiation.

Debt limit: Although the timing is uncertain, analysts expect the Treasury Department’s measures for making payments on government debt will be exhausted before the end of the year. As always, Congress can simply vote to raise the debt ceiling to honor the obligations that they themselves have voted to incur. Beyond that, the debt ceiling could be scrapped altogether, an approach recommended in a recent GAO report. That would remove the recurrent threat of US government default, a threat which the GAO found harms the economy. Will Congress act rationally or will we be treated to another game of chicken regarding the nation’s economic health?

The dilemma for Republican Congressional leaders in all of these cases is that a significant part of their base both in and out of Congress wants to use these must-pass bills as “hostage-taking” opportunities to extract policy changes. However, both the policy changes themselves and the repeated threats of shut-down and default tend to be unpopular with the larger voting public.

The health care tie-in?  In some of cases—e.g. limiting access to family planning services by defunding PPFA—the connection is very direct. In other cases, the impact comes more from the economic harm that could be done to vulnerable populations, via benefit cuts or government shutdown and also because each “hostage-taking” incident represents a threat to vital health and social-welfare programs. In either event, health care advocates will need to keep a close eye on these developments and be prepared to pressure Congress to do the right thing.

A funny thing happened on the way to budget reconciliation

Following the victory in King v. Burwell it seemed that the appetite for another symbolic attempt to repeal the ACA was waning, but now it appears to be back in full force. What happened? Senators went home and talked to their base voters. Although ACA repeal continues to lose steam with the general public, it still commands a majority within the Republican Party. Hence the fruitless repeal votes will continue.

More victories for CTG but some states still don’t get the message

Following on the votes in the Montana legislature to close the coverage gap by accepting federal funds to provide insurance to low income adults, two more states in the West seem poised to follow suit. Governor Bill Walker of Alaska announced that he would move ahead with closing the coverage gap and negotiators in Utah announced a breakthrough in their talks will also likely lead to expansion. That would make three states in the western part of the country moving forward this year. As the number of states refusing the overwhelming logic in favor of coverage declines it becomes harder and harder, given the geography and demography of states and people in the coverage gap, to ignore the continuing role of race in shaping our politics. While symbolic actions, such as removing the confederate battle flag in South Carolina are a step forward, more concrete actions to close disparities in health and economic wellbeing are necessary. There is no better place to start than closing the coverage gap. 

Fifty years ago this week Medicaid and Medicare were signed into law. These two programs provide children, seniors, people living with disabilities and working families with access to the health care they need. To celebrate 50 years of these two programs, each day this week one of our partners will share a story about their work to ensure more people can access Medicaid. We’ll also be reflecting on the two programs and what’s ahead. 

On Medicaid’s 50th anniversary, it’s worth a look back at how the biggest expansion in the program’s history has helped Coloradans.

In Colorado, we place a lot of value on common-sense solutions that make our residents healthier while being fiscally responsible. That’s why we accepted federal funds to cover more Coloradans with bipartisan support in the state legislature and with a broad coalition of consumers, businesses, and the health care industry.

It turns out, that sort of collaboration pays off.

Since the state closed the coverage gap and expanded the Medicaid program in January 2014, more than 400,000 Coloradans got covered through Medicaid, meaning they can now get the low cost care they need to stay healthy.

A new report from the State Health Reform Assistance Network shows, perhaps surprisingly, that expanding coverage to so many people has actually saved the state money. In 2014, alone, we saved $147 million, and we are on track to save an additional $160 million this year. Those savings are right in line with projections from a 2013 report by the Colorado Health Foundation issued during the debate in Colorado.

Accepting the federal funds was a good deal for Colorado because federal dollars cover 100 percent of the cost of new enrollees, as well as some current enrollees, for the first few years. It has also reduced Colorado’s tab on non-Medicaid costs, such as hospitalizations for prison inmates, to the tune of $10 million per year. Of course, spending fewer state dollars on health care also frees up needed cash for other priorities, and these realized savings can be channeled to other critical investments like education and transportation.

According to the head of the state’s Medicaid department, average costs per enrollee have declined 9 percent in recent years. The data show we’re getting a better bang for our buck in Colorado. That’s due in part to innovative approaches like care coordination to achieve better quality care. It’s also due to the fact so many newly enrolled consumers are younger folks who tend to use less medical care. In 2015, 25 percent of new Medicaid enrollees are kids under 18, and another 35 percent are young adults between the ages of 18 – 34.

Since 2013, we’ve gone from approximately 700,000 Coloradans covered to more than 1.1 million. These Coloradans can finally access care they haven’t received for years, and they can have the peace of mind they need to focus on the many other competing priorities in life – paying rent, finishing college, getting the kids off to school and helping with their homework, performing well at work, and all the rest.

Impact to the State’s Economy

This is all great news for the Coloradans who now have coverage. It’s good for our budget and taxpayers. And it’s also good news for the Colorado economy.

The 2013 report by The Colorado Health Foundation estimated that Medicaid expansion would add 14,357 jobs, primarily in health care, and $2.04 billion to Colorado’s GDP by June 2015. While the direct impact of Medicaid expansion in Colorado has not yet been analyzed, we have seen over 89,000 jobs created in the state since access to Medicaid coverage increased in January 2014. Some 21,000 of those jobs were in the education and health services sector, leading the state in job growth.

As we reflect on Medicaid’s 50th anniversary, we should be proud of the progress we’ve made together. After all, hardworking Coloradans deserve health care they can count on.

Ryan Biehle
Policy & Legislative Associate
Colorado Consumer Health Initiative

Medicaid provides health and financial security for millions of low-income, working Americans. Despite the fact that Medicaid is as efficient as (or even more efficient than) private insurance, it is often a target of state budget cuts. As we look to the future of Medicaid, advocates will need to play a vocal role in Medicaid budget discussions, both to defend Medicaid from harmful cuts, and to direct the discussion toward meaningful reform. Rhode Island and Ohio are two tales that illustrate how persistent advocate engagement in Medicaid reform is beneficial and critically important for consumers and state budgets.

Rhode Island: A Tale of Reform

Concerns about costs resulted in calls to dramatically reduce Rhode Island’s Medicaid budget. Luckily, consumer-friendly leaders like Governor Gina Raimondo (D) and other key officials set a positive tone for the state’s Medicaid reform efforts. Earlier this year, Governor Raimondo created the ‘Working Group to Reinvent Medicaid,’ with a goal to reform the Medicaid system over the long term while cutting $90 million from the Medicaid budget in 2015. 

With policymakers, advocates and industry representatives invited to the table, the Working Group proposed initial recommendations for FY15-16 budget savings that are a win-win for the state and consumers. These recommendations implement programs advocates have long been calling for. Below are a few highlights from the Working Group’s report, in which Rhode Island’s Medicaid program will:

  • Aim to reduce unnecessary hospital utilization
  • Improve quality and develop new payment arrangements that award value over volume
  • Temporarily decrease hospital payment rates and increase provider assessments
  • Pilot a hospital-based Accountable Care Organization (ACO) model that focuses on patients with long-term and complex needs

A final report with recommendations for long term reforms was published  and presented to Governor Raimondo earlier this month.

Ohio: A Tale of Advocate Intervention

In Ohio, Governor John Kasich (R) proposed dramatic rollbacks in coverage for certain Medicaid benefits. Unlike in Rhode Island, consumer health advocates were not invited to the table to help design savings initiatives. As a result, the state advanced harmful proposals that would make coverage harder to access.

Although they were not part of the initial policy discussion, advocates immediately jumped into action.

  • They challenged the harmful assumptions that the cuts would save money and that beneficiaries could get care through other means by using data and policy analysis.
  • Advocates organized call-in days, sign-on letters, and sent action alerts to their lists.
  • Advocates also found a legislative champion in the Republican Party (Republicans the state Senate and House) to introduce an amendment to these proposals.
  • They then called on strategic stakeholders and partners to carry the message. For instance, advocates worked with the Ohio chapter of the American Cancer Society to lobby against cuts to breast and cervical cancer screening coverage.

Advocates’ efforts paid off. They prevented rollbacks in eligibility for pregnant people and coverage for cervical and breast cancer screening. Unfortunately, the state still cut coverage for family planning services and health savings accounts, increased cost-sharing for some, and blocked the expansion of an innovative coordinated care model.

The Moral of the Stories

What lessons do the tales of these states teach us?

  1. Start early. It’s never too early to meet with your coalition and start planning to defend and/or reform Medicaid. Medicaid is chronically on the chopping block during state budget deliberations, so working with your coalition partners to proactively develop a Medicaid reform agenda will prepare you for this eventuality. It can also serve as a guide and reference for educating the public and lawmakers about the importance of this program. In addition to Rhode Island’s Reinventing Medicaid reports, check out Arkansas Advocates for Children and Families’ Top Ten Principles for Health Reform.
  2. Educate policymakers about the importance and benefits of Medicaid. Work with legislators to develop smart, consumer-friendly reforms to the Medicaid system, and cultivate them into champions for these reforms. Leverage your coalition partners and grassroots organizers to amplify the message through legislative meetings, lobby days, in-district events, and the media.
  3. Be creative. While planning your Medicaid defense/reform agenda, consider how Medicaid funds social services outside of the traditional health care system, such as supportive housing and housing infrastructure, early childhood development, and mental health and substance use disorder services. Explore how you can integrate the message of Medicaid system reform into these spaces, as well as pull unlikely partners into your Medicaid campaign.
  4. Collect data and stories. Press your state Marketplace and Medicaid office for data on who is falling through the gaps and who is churning off of Medicaid due to cuts. Boost this data with stories of real consumers who are falling through new coverage gaps. Refer to the Families USA story-banking toolkit for more resources to help you collect stories.
  5. Grow your lists and mobilize your grassroots. Lift up the voices of consumers who are falling through the gaps by helping consumers understand how to connect with their legislators. Advocates can also organize activities for consumers to engage in throughout the year so that legislators understand what their constituencies want before they need to start budget negotiations.

We know that this is not an easy battle, nor a new one. But we encourage you to get creative, strengthen old partnerships and engage new ones. Let’s work together to shift the conversation away from harmful cuts, and toward “Reinventing Medicaid.”