Health Care Reform Role Of The States Cost Containment Impact On Medicare Impact On Medicaid And Low Income People Serial No 103 90 PDF Download

Executive Summary: There will be considerable debate as the nation moves forward to reform the health care system to both control costs and address coverage for millions of Americans lacking health insurance. Medicaid's role for the low-income population provides a strong platform on which reform efforts to expand coverage can be built as two-thirds of the nation's uninsured are low-income. Medicaid has proven to be an effective vehicle for improving access and health outcomes for low-income and high-need populations. It is a tested program with an administrative structure in every state that has been a foundation for state health reform efforts designed to expand coverage for their low-income residents. However, under current law, non-disabled adults without dependent children are not eligible for Medicaid coverage, even if they are very poor. Medicaid coverage could be broadened to reach more of the low-income uninsured by eliminating categorical restrictions and establishing a consistent, simplified national eligibility standard for the program based on income. This paper estimates that 49 million Americans are uninsured in 2009 and analyzes several options to show the impacts on coverage and cost of expanding Medicaid to cover more low-income uninsured populations. The two options we highlight are: -- Option 1: An expansion of children to 250% FPL and adults to 100% FPL -- Option 2: An expansion of children to 300% FPL and adults to 150% FPL We also examine the options of only expanding coverage to adults to these levels. For these options we assume current participation rates (between 60% and 70%) and also higher participation rates (90%). Participation at 90% approximates the levels under an individual mandate. The paper focuses on the results assuming the enhanced participation because the Medicaid expansions are expected to be part of broader health reform efforts that would strive for near universal coverage. In addition to cost and coverage, the analysis shows the impacts of the options by region and with payment rates adjusted upward to promote provider participation. These estimates reflect the medical costs of coverage for 2009 assuming full implementation of the options. The estimates do not include other costs such as outreach or new policies to achieve broader participation; therefore estimates of legislation would likely differ.