Arkansas: Replacing Medicaid Expansion with Obamacare's Exchanges | TigerDroppings.com

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Interception
Providence Fan
Member since Nov 2008
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Arkansas: Replacing Medicaid Expansion with Obamacare's Exchanges


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Arkansas: Replacing Medicaid Expansion with Obamacare's Exchanges Could Require 'No Additional Federal Costs At All'

quote:

On February 26, Gov. Beebe told members of his Republican-controlled legislature that, after a face-to-face meeting with Health and Human Services Secretary Kathleen Sebelius, the Obama administration had agreed to allow Arkansas to expand its subsidized insurance exchanges to the low-income population that the law had otherwise slated to gain coverage under Medicaid.

“Basically [HHS has] agreed to give us about everything that we’ve asked for,” said Beebe. “What that really amounts to is taking the Medicaid population that would be expanded…and use those federal Medicaid dollars and purchase insurance through the exchange. So they would buy private insurance through the exchange for the entire population, and [HHS has] given us permission to do that.”


quote:

Expanding the exchanges would improve their cost-efficiency

The Arkansas Department of Human Services, however, came to a different estimate than the CBO did. DHS hired Optumas, an actuarial consulting firm, and worked with legal consultants and the Arkansas Insurance Department to come up with an Arkansas-specific estimate of the fiscal cost of expanding the exchanges instead of Medicaid. “These Arkansas estimates,” writes DHS in a memo, “are less than one-third of the Congressional Budget Office cost estimate widely cited in press accounts.”

DHS cites three principal differences between their estimates and CBO’s. First, the CBO only estimated the cost of expanding exchanges to adults between 100 and 138 percent of the federal poverty level, compared to the 0-138 percent expansion envisioned in Arkansas.

Second, expanding the exchanges instead of Medicaid would result in a “market transformation” that would double the risk pool in the exchanges, improving the market power of exchange plans, while increasing competition among the plans to provide a cost-efficient service.

Third, the CBO estimate assumed a wide gap between Medicaid’s payments to doctors and hospitals, relative to those from exchange-based plans. DHS estimates that the actual difference in Arkansas is less than 25 percent, much narrower than the national average.


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If Arkansas is right, Obamacare will be transformed

There can be little doubt that private insurers in the exchanges would provide far superior coverage to the poor than Medicaid would. The biggest roadblock to expanding the exchanges has been their significantly higher fiscal cost. If the new Arkansas analysis is sound, however, that concern could be alleviated in dozens of states that are currently on the fence, especially those states in which Medicaid reimbursement rates are closer to those of private insurers.

Indeed, there are 23 states with higher Medicaid reimbursement rates (relative to Medicare’s) than Arkansas, when it comes to overall physician services: Georgia, Virginia, Oregon, Louisiana, South Carolina, Washington, Kansas, Vermont, North Carolina, South Dakota, Iowa, Connecticut, Delaware, Oklahoma, Nebraska, North Dakota, Idaho, Montana, Nevada, Arizona, New Mexico, Alaska, and Wyoming. In these states, and also in eight states slightly below Arkansas in reimbursement rates—Alabama, Massachusetts, Mississippi, Maryland, Colorado, Kentucky, Wisconsin, and West Virginia—expanding Medicaid via the exchanges might be a truly realistic and cost-effective option.


There is no question that expanding Medicaid is a death nail to states like Louisiana. The Feds would pay the first 3 years but then Louisiana is on the hook for 10% of the cost after that when cost start to explode. If the Arkansas actuaries are correct in their numbers then Jindal should adopt this plane ASAP and buck Medicaid expansion.



This post was edited on 3/23 at 7:40 pm



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SmackoverHawg
Arkansas Fan
Member since Oct 2011
12049 posts

re: Arkansas: Replacing Medicaid Expansion with Obamacare's Exchanges


Flagship!!!





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Interception
Providence Fan
Member since Nov 2008
11089 posts

re: Arkansas: Replacing Medicaid Expansion with Obamacare's Exchanges


I would love to have Governor Beebe in Baton Rouge. He is a good governor.





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matthew25
Ole Miss Fan
Member since Jun 2012
3289 posts

re: Arkansas: Replacing Medicaid Expansion with Obamacare's Exchanges


I believe the feds pay 100% in 2014, 2015 and 2016.

96% in 2017; 94% in 2018; 92% in 2019, and then 90% in 2020


That said, is Arkansas adopting the Paul Ryan model, give the recipient money to buy coverage on the Arkansas State Ins. Exchange ??






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wegotdatwood
Arkansas Fan
Member since Aug 2009
17094 posts

re: Arkansas: Replacing Medicaid Expansion with Obamacare's Exchanges


Yet another win over Louisiana.





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Interception
Providence Fan
Member since Nov 2008
11089 posts

re: Arkansas: Replacing Medicaid Expansion with Obamacare's Exchanges


quote:

96% in 2017; 94% in 2018; 92% in 2019, and then 90% in 2020


You're right, I was just giving people an idea of what happens after the first 3 years.

quote:

That said, is Arkansas adopting the Paul Ryan model, give the recipient money to buy coverage on the Arkansas State Ins. Exchange ??


No, currently the federal government is providing matching and open-ended funds to states, which each run their own Medicaid program. The Ryan plan would instead give states a Block Grant with a hard annual cap that would be adjusted to population growth and inflation. In turn, states have more flexibility in setting up the parameters for Medicaid.

I believe that states could replace the money with state funds, but would be unlikely/ willing to do so to any significant degree. The Ryan Plan will curtail eligibility for Medicaid, provide less extensive coverage to beneficiaries, or pay more themselves than would be the case under current law. This all ends up requiring states to reduce payments to providers. In turn, Ryan is proposing to cut Mediaid enrollment by starving states of Federal money.

The Arkansas Medicaid Plan allows for more expansive coverage while Medicaid enrollees will see premiums somewhere between Medicare and Commercial rates. If the premiums are 20% less than the Commercial Rates then average per-person government subsidy of an exchange plan could be closer to $7,500, not $9,000. $7,500 is “only” 25 percent higher than Medicaid’s $6,000 per-person rate. (This is different than the CBOs 50%)

Note: These premiums would probably decrease over time as insurance companies would continue to compete for those contracts.





This post was edited on 3/24 at 1:05 am


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WeeWee
LSU Fan
Pyongyang, North Korea
Member since Aug 2012
1830 posts

re: Arkansas: Replacing Medicaid Expansion with Obamacare's Exchanges


I hope this turns out better than all of arky's preseason national championships.





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ShortyRob
LSU Fan
Savannah, GA
Member since Oct 2008
25488 posts
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re: Arkansas: Replacing Medicaid Expansion with Obamacare's Exchanges


quote:

There is no question that expanding Medicaid is a death nail


Just because little shite like this makes me obsessive compulsive, a bit of help for you. It's "death knell", not "death nail".






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Zed
Alabama Fan
Member since Feb 2010
7819 posts

re: Arkansas: Replacing Medicaid Expansion with Obamacare's Exchanges


I don't have a problem with Arkansas trying this out at the state level. We'll see what happens.





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Porky
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re: Arkansas: Replacing Medicaid Expansion with Obamacare's Exchanges


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I hope this turns out better than all of arky's preseason national championships.

I do too.






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Taxing Authority
LSU Fan
Houston
Member since Feb 2010
21202 posts

re: Arkansas: Replacing Medicaid Expansion with Obamacare's Exchanges


quote:

There is no question that expanding Medicaid is a death nail to states like Louisiana. The Feds would pay the first 3 years but then Louisiana is on the hook for 10% of the cost after that when cost start to explode.
Ah. The cocaine dealer strategy.

quote:

If the Arkansas actuaries are correct in their numbers then Jindal should adopt this plane ASAP and buck Medicaid expansion.
Sure. This is why state-level policies > federal level policies.

Time will tell.






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tigerskin
LSU Fan
Member since Nov 2004
9250 posts

re: Arkansas: Replacing Medicaid Expansion with Obamacare's Exchanges


Wouldn't the cheapest policies on the exchange have very high deductibles?





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Zed
Alabama Fan
Member since Feb 2010
7819 posts

re: Arkansas: Replacing Medicaid Expansion with Obamacare's Exchanges


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Wouldn't the cheapest policies on the exchange have very high deductibles?
As regulated as the exchanges will be, there's probably some type of limit on deductibles.






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tigerskin
LSU Fan
Member since Nov 2004
9250 posts

re: Arkansas: Replacing Medicaid Expansion with Obamacare's Exchanges


Yep, just looked it up. Deductible limit will be 2000 for individuals, 4000 for families. Going to be very interesting to see these exchange prices.


This post was edited on 3/24 at 11:58 am


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Interception
Providence Fan
Member since Nov 2008
11089 posts

re: Arkansas: Replacing Medicaid Expansion with Obamacare's Exchanges


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quote:

Benefit Mandates (also effective Jan. 1, 2014):

Limit deductibles for health plans in the small group market to $2,000 for individuals and $4,000 for families unless contributions are offered that offset deductible amounts above these limits. This deductible limit will not affect the actuarial value of any plans.

Limit any waiting periods for coverage to 90 days.
Allow states the option of merging the individual and small group markets.

Create an essential health benefits package that provides a comprehensive set of services, covers at least 60% of the actuarial value of the covered benefits, limits annual cost-sharing to the current law HSA limits ($5,950/individual and $11,900/family in 2010), and is not more extensive than the typical employer plan.

Require all qualified health benefits plans, including those offered through the Exchanges and those offered in the individual and small group markets outside the Exchanges, except grandfathered individual and employer-sponsored plans, to offer at least the essential health benefits package.

The states are also required in the individual and small group markets (including the Exchnages) to offer four distinct benefit tiers that cover at least 90%, 80%, 70%, and 60% respectively of the actuarial value of the covered benefits similar to what is listed above in describing the essential benefits package.






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Zed
Alabama Fan
Member since Feb 2010
7819 posts

re: Arkansas: Replacing Medicaid Expansion with Obamacare's Exchanges


quote:

Going to be very interesting to see these exchange prices.
It'll be an interesting test for expanded exchanges. If it goes well enough, maybe it spurs medicaid changes?






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tigerskin
LSU Fan
Member since Nov 2004
9250 posts

re: Arkansas: Replacing Medicaid Expansion with Obamacare's Exchanges


If there are some low exchange prices, most health insurance for everyone will be through the exchanges. I would imagine some insurance company is going to offer a cheaper plan with resultant big cuts to providers. Still will have the issue of forcing providers to accept it.





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VOR
New Orleans Pelicans Fan
New Orleans
Member since Apr 2009
39558 posts

re: Arkansas: Replacing Medicaid Expansion with Obamacare's Exchanges


I seem to recall that a few months ago I posted a question as to why Louisiana was not participating in an exchange and was told that Jindal was doing the right thing by completely ignoring the ACA and not participating in any way.





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Interception
Providence Fan
Member since Nov 2008
11089 posts

re: Arkansas: Replacing Medicaid Expansion with Obamacare's Exchanges


quote:

I seem to recall that a few months ago I posted a question as to why Louisiana was not participating in an exchange and was told that Jindal was doing the right thing by completely ignoring the ACA and not participating in any way.


We have a significantly higher Medicaid expense per capita than most states. If mandated by the Feds and implemented by the states there is no wiggle room in offsetting the cost of the program. You can't blame any Republican Governor for being apprehensive about expanding Medicaid?

Now, some of it is political posturing by Jindal but he might have been right in waiting for a better deal.






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WeeWee
LSU Fan
Pyongyang, North Korea
Member since Aug 2012
1830 posts

re: Arkansas: Replacing Medicaid Expansion with Obamacare's Exchanges


quote:

We have a significantly higher Medicaid expense per capita than most states. If mandated by the Feds and implemented by the states there is no wiggle room in offsetting the cost of the program. You can't blame any Republican Governor for being apprehensive about expanding Medicaid?



Our medicaid cost are extremely high plus we already have one semi-public health system (LSU health) that is a financial clusterfart. I hope Arky's plan works out because if R's can't win back the whit house and get Obamacare replaced we are going to need a way to save it. Or here comes single payer and 20% more women will die of breast cancer every year.






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