{"id":6638,"date":"2017-06-07T19:51:04","date_gmt":"2017-06-08T01:51:04","guid":{"rendered":"http:\/\/admin.patheos.com\/blogs\/janetheactuary\/?p=6638"},"modified":"2017-06-07T19:51:19","modified_gmt":"2017-06-08T01:51:19","slug":"oh-fun-medicaid","status":"publish","type":"post","link":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2017\/06\/oh-fun-medicaid.html","title":{"rendered":"Oh, fun – Medicaid for all!"},"content":{"rendered":"\n<\/head>

\"https:\/\/commons.wikimedia.org\/wiki\/File%3ADoctor_examines_patient_(1).jpg;<\/p>\n

That\u2019s what\u2019s on tap in Nevada, though there are few details available at the moment. \u00a0Vox reports<\/a> that<\/p>\n

\n

The Nevada legislature passed a bill<\/a> Friday that would allow anyone to buy into Medicaid, the public program that covers low-income Americans. It would be the first state to open the government-run program to all residents, regardless of their income or health status.<\/p>\n

The bill is currently sitting with Nevada Gov. Brian Sandoval, a Republican. His office did not respond to an inquiry about whether he would sign the bill or veto it. . . .<\/p>\n

Sprinkle (who told me his last name has led to some people calling the plan SprinkleCare) says they haven\u2019t yet estimated how much enrolling in the Nevada Care Plan would cost individuals. The bill sponsors also have not determined whether buy-in Medicaid members would have a deductible or traditional copayments, which Medicaid typically does not have because of the low-income population it serves. . . .<\/p>\n

On average, Medicaid pays 66 percent of what Medicare pays doctors.<\/p>\n

In Nevada, Medicaid pays 81 percent of Medicare rates.<\/p>\n

This has the advantage of keeping Medicaid a relatively low-cost program per person \u2014 but also the disadvantage of some doctors deciding not to accept Medicaid\u2019s lower rates. A recent federal survey estimates that 68.9 percent of doctors are accepting new Medicaid patients, compared to 84.7 percent accepting new patients with private insurance.<\/p><\/blockquote>\n

The lack of detail means there\u2019s not much to say about this bill \u2014 though I am surprised that there isn\u2019t any sort of legislative analysis, in the way that there was for the California single-payer proposal<\/a>. \u00a0But here\u2019s what I\u2019ve been able to find out:<\/p>\n

First of all, Medicaid is actually pretty danged cheap in Nevada \u2013 at least as of 2011, which seems to be the most recent available data. \u00a0According to Kaiser<\/a>, the state spent $2,367 per adult and $1,940 per child,that is, if you exclude the disabled and the elderly. \u00a0That\u2019s remarkably cheap, though I couldn\u2019t find an apples-to-apples comparison for privately-insured (employer-provided) adults, except that Milliman<\/a> calculated a per-family-of-four cost of $26,000 in 2016, which compares to $8,614 for Nevada Medicaid.<\/p>\n

So Vox reports that Medicaid pays 81% of Medicare rates in Nevada, and commercial insurance rates, if I\u2019m not mistaken, are 5 \u2013 10% higher than Medicare (that comes from a vaguely-remembered offhand comment from my brother, who works in healthcare). \u00a0That\u2019s a far cry from this differential of 3 times!<\/p>\n

How does Medicaid provide their coverage for so much less? \u00a0Probably a couple reasons:<\/p>\n

These figures are apples and oranges \u2014 the equivalent 2011 figure in the Milliman study was $19,000. \u00a0There are also likely at least some disabled people in Milliman\u2019s figure, whether it\u2019s dependents of employees or the small number of disabled who are employed and receive employer-provided health insurance.<\/p>\n

The overall healthcare costs in Nevada could well simply be less, as a lower-cost state.<\/p>\n

Potentially the reported per-beneficiary costs exclude the state\u2019s costs to run the program, and only looks at the money paid out to providers.<\/p>\n

And I suspect that Medicaid beneficiaries are lower-cost than average, if you strip the disabled out. \u00a0After all, even under the expanded 133% of poverty eligibility, you\u2019re more likely to qualify if you have children, rather than being an empty-nester, because the income cut-off increases with more people in the household; plus, you are simply more likely to have above-poverty income as you get older, don\u2019t you think? \u00a0And since healthcare expenses are higher for the 50-somethings, this should have an impact. \u00a0Plus, for all the reports of Medicaid recipients going to the ER for pregnancy tests, I wouldn\u2019t be surprised if in other respects their costs were lower, because they\u2019re less likely to be doing the research involved in seeking out high-cost cancer treatments, or knee replacements, or the like.<\/p>\n

But is the lower cost of Medicaid \u201cproof\u201d that single-payer is more cost-efficient?<\/p>\n

Interestingly, the answer is \u201cno\u201d \u2013 but not for the reason you\u2019d expect.<\/p>\n

What the Vox article misses is that Nevada\u2019s standard Medicaid benefit is not single payer<\/strong>. \u00a0According to (undated) documentation from the state<\/a>,<\/p>\n

All Medicaid recipients who live in urban Washoe County (Reno) or Clark County (greater Las Vegas area) who are not determined disabled by the Social Security Administration are mandated,<\/p><\/blockquote>\n

that is, must receive their Medicaid benefits through one of two managed care organizations. \u00a0Health Plan of Nevada is a subsidiary of United Healthcare, and Amerigroup\u2019s parent company is Anthem.<\/p>\n

So having spent more time digging into this than I probably should have, I\u2019m now just more irritated at the lack of information. \u00a0What makes these plans more attractive for potential buy-in recipients than the usual \u201cmarketplace\u201d plans? \u00a0What drives the lower costs? \u00a0Is the \u201csocial compact\u201d acceptance of lower rates by providers at risk if the state widens eligibility too much, and opens up the plans to \u201cfree riders\u201d of a sort? \u00a0Or would the rates for buy-in, if actuarially- rather than politically-determined, be significantly higher than the state\u2019s current Medicaid spending?<\/p>\n

Inquiring minds want to know.<\/p>\n

\u00a0<\/p>\n

Image: \u00a0yes, I keep using the same generic \u201cdoctor examining a patient\u201d pic. \u00a0https:\/\/commons.wikimedia.org\/wiki\/File%3ADoctor_examines_patient_(1).jpg; By Unknown photographer [Public domain], via Wikimedia Commons<\/p>\n<\/body><\/html>\n","protected":false},"excerpt":{"rendered":"

That\u2019s what\u2019s on tap in Nevada, though there are few details available at the moment. \u00a0Vox reports that The Nevada legislature passed a bill Friday that would allow anyone to buy into Medicaid, the public program that covers low-income Americans. It would be the first state to open the government-run program to all residents, regardless […]<\/p>\n","protected":false},"author":2209,"featured_media":5217,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[356,545],"class_list":["post-6638","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","tag-health-insurance","tag-medicaid"],"yoast_head":"\nOh, fun - Medicaid for all!<\/title>\n<meta name=\"description\" content=\"That's what's on tap in Nevada, though there are few details available at the moment. \u00a0Vox reports that The Nevada legislature passed a bill Friday that\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2017\/06\/oh-fun-medicaid.html\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Oh, fun - 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