re: Louisiana Medicaid projected $650,000,000 under budget for FY

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You clearly have no idea how Medicaid works.

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Do you? I am involved with writing Medicaid policy for a state that has expanded Medicaid. What do you want to talk about?

You might want to go back and reread carefully all the "may", "could", "might", "possibly" in that article

Because its just 6 months in, folks haven't caught on yet

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Louisiana Medicaid projected $650,000,000 under budget for FY

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1. Wait until the year is over. Mid-year projections are never right.

2. 1 mid-year projected surplus doesn't mean shite. Show me a 3-5 year end of the year surplus and you might convince that the medicaid expansion was a good thing.

ETA:

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Amazing what happens when people get access to primary care instead of flooding the ER.

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If you're really 4 years out of med school as you claim to be, then you should be able to understand the following.

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The effect of Medicaid coverage on health and the use of health care services is of first-order policy importance, particularly as policymakers consider expansions of public health insurance. Estimating the effects of expanding Medicaid is challenging, however, because Medicaid enrollees and the uninsured differ in many ways that may also affect outcomes of interest. Oregon’s 2008 expansion of Medicaid through random-lottery selection of potential enrollees from a waiting list offers the opportunity to assess Medicaid’s effects with a randomized evaluation that is not contaminated by such confounding factors. In a previous examination of the Oregon Health Insurance Experiment, we found that Medicaid coverage increased health care use across a range of settings, improved financial security, and reduced rates of depression among enrollees, but it produced no detectable changes in several measures of physical health, employment rates, or earnings.1-4

A key finding was that Medicaid increased emergency department (ED) visits by 40% in the first 15 months after people won the lottery.3 This finding was greeted with considerable attention and surprise, given the widespread belief that expanding Medicaid coverage to more uninsured people would encourage the use of primary care and thereby reduce ED use. Many observers speculated that the increase in ED use would abate over time as the newly insured found alternative sites of care or as their health needs were addressed and their health improved. One commentator, for example, raised the question, “But why did these patients go to the ED and not to a primary care office?” He hypothesized that “Despite the earlier finding that coverage increased outpatient use, many of these newly insured patients probably had not yet established relationships with primary care physicians. If so, the excess ED use will attenuate with time.”5

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ED visits actually go up after medicaid expansion.

[quote]For policymakers deliberating about Medicaid expansions, our results, which draw on the strength of a randomized, controlled design, suggest that newly insured people will most likely use more health care across settings — including the ED and the hospital — for at least 2 years and that expanded coverage is unlikely to drive substantial substitution of office visits for ED use.[/quote] NEJM

Here is another study showing ED visits rising after medicaid expansion.
Here is a 3rd study showing ER visits rising after medicaid expansion

Louisiana is still within the first 2 year window after medicaid expansion, so it is highly unlikely that decreased ER usage is the reason why there is a mid-year projected surplus.

Have no fear Honor Code tax man is here!

Your idealism will die the day you rely on reimbursement from Medicaid.

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Message Louisiana Medicaid projected $650,000,000 under budget for FY by WeeWee quote: Louisiana Medicaid projected $650,000,000 under budget for FY 1. Wait until the year is over. Mid-year projections are never right. 2. 1 mid-year projected surplus doesn't mean shite. Show me a 3-5 year end of the year surplus and you might convince that the medicaid expansion was a good thing. ETA: quote: Amazing what happens when people get access to primary care instead of flooding the ER. If you're really 4 years out of med school as you claim to be, then you should be able to understand the following. quote: The effect of Medicaid coverage on health and the use of health care services is of first-order policy importance, particularly as policymakers consider expansions of public health insurance. Estimating the effects of expanding Medicaid is challenging, however, because Medicaid enrollees and the uninsured differ in many ways that may also affect outcomes of interest. Oregon’s 2008 expansion of Medicaid through random-lottery selection of potential enrollees from a waiting list offers the opportunity to assess Medicaid’s effects with a randomized evaluation that is not contaminated by such confounding factors. In a previous examination of the Oregon Health Insurance Experiment, we found that Medicaid coverage increased health care use across a range of settings, improved financial security, and reduced rates of depression among enrollees, but it produced no detectable changes in several measures of physical health, employment rates, or earnings.1-4 A key finding was that Medicaid increased emergency department (ED) visits by 40% in the first 15 months after people won the lottery.3 This finding was greeted with considerable attention and surprise, given the widespread belief that expanding Medicaid coverage to more uninsured people would encourage the use of primary care and thereby reduce ED use. Many observers speculated that the increase in ED use would abate over time as the newly insured found alternative sites of care or as their health needs were addressed and their health improved. One commentator, for example, raised the question, “But why did these patients go to the ED and not to a primary care office?” He hypothesized that “Despite the earlier finding that coverage increased outpatient use, many of these newly insured patients probably had not yet established relationships with primary care physicians. If so, the excess ED use will attenuate with time.”5 ED visits actually go up after medicaid expansion.

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For policymakers deliberating about Medicaid expansions, our results, which draw on the strength of a randomized, controlled design, suggest that newly insured people will most likely use more health care across settings — including the ED and the hospital — for at least 2 years and that expanded coverage is unlikely to drive substantial substitution of office visits for ED use.

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NEJM Here is another study showing ED visits rising after medicaid expansion. Here is a 3rd study showing ER visits rising after medicaid expansion Louisiana is still within the first 2 year window after medicaid expansion, so it is highly unlikely that decreased ER usage is the reason why there is a mid-year projected surplus

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Wee wee gets it.

Search the Advocate twelve months ago. This is the second year in a row LDH has promoted a surplus.

Like I posted last year, the LDH press releases are regularly modified and amended as needed, and according to the anticipated audience.

..."LDH's fiscal forecast report predicts that, because of the infusion of federal dollars tied to Medicaid, the department will end the budget cycle next June with a modest $2.85 million surplus, after facing deficits in five of the previous six years." Unfortunately, the Advocate has yet to follow up on that press release, because LDH immediately revised their numbers following their October PR push. When the anticipated fiscal report was compiled in December, it was quietly noted that the roughly $3 million surplus was revised to a $300 million deficit. That number has been further revised in the January report, which currently stands at a $340 million deficit for the current fiscal year.