Saturday, December 21, 2013

Utah May Substitute Private Insurance for Medicaid Expansion

This is a better solution to reform our healthcare and get more people insured. This is from Kirsten Stewart at The Salt Lake Tribune

... A Legislative Health Reform Task Force on Thursday revisited, tweaked and approved [Medicaid] expansion scenarios for recommendation to the full Legislature. ...

Two plans are being pitched. Both would allow the state to cover the same number of Utahns who would have been eligible for Medicaid under a full expansion — 111,000 adults earning up to 138 percent of the poverty level, or $32,000 for a family of four — without growing the government program.

They also would strengthen the private insurance market and eliminate the risk of "crowd-out," or privately insured low-wage workers migrating to Medicaid, said the task force chairman, Rep. Jim Dunnigan, R-Taylorsville.

• One option would be to use public dollars to buy private insurance for residents with incomes under the federal poverty level. Those earning at least the poverty level or up to 138 percent of that amount would shop with federal subsidies on the federal health exchange,

• Another would be to use public dollars to buy private insurance for the full expansion population, those earning up to 138 percent of poverty.

... Utah Republican Gov. Gary Herbert isn’t expected to make a decision about expanding Medicaid until January, a call that must be approved by the Legislature. Any bill passed by lawmakers likely wouldn’t take effect until May, and then there’s the matter of securing federal approval. ...

In states that opt for full expansion, the federal government has agreed to pay 100 percent of those costs through 2017, and thereafter declining amounts but no less than 90 percent.

The U.S. Centers for Medicare and Medicaid (CMS) had previously said anything short of a full expansion would be funded at Utah’s current 70/30 split, with the feds picking up 70 percent of the costs.

This risked Utah losing hundreds of millions in federal funding.

But CMS has subsequently backed off, approving privatized Medicaid plans first pitched by Arkansas, and more recently, Iowa.

There are many unanswered questions, such as whether commercial health plans on the exchange have different coverage and cost-sharing than Medi­caid. Additionally, Utah wants to also allow low-income residents to put subsidies toward the purchase of employer-based coverage, which hasn’t been proposed by any other state. ...