Today’s Managing Health Care Costs Number is 28 million
Federal Poverty Level
The Affordable Care Act has dramatically decreased the number of uninsured in the US . This is uneven; the decrease is most dramatic in “blue” states and the rare “red” states which expanded Medicaid. There are many adults who work but are still under 133% of federal poverty level (FPL, which is over $32,000 for a family of four). In Alabama, which did not expand Medicaid, childless adults are never eligible for Medicaid, and parents are eligible if they make under 18% of the FPL (or under $4400 a year for a family of four).
There’s still a big problem, highlighted in an Upshot essay in the New York Times by Dhruv Kullar, a resident at Mass General.
Up to 28 million people may move between plans annually, according to a 2011 study by Benjamin Sommers at Harvard and Sara Rosenbaum at George Washington University. Over the course of four years, only 19 percent of adults will remain continuously eligible for Medicaid and 31 percent continuously eligible for marketplace subsidies. Almost 40 percent will have churned more than four times during this period.
It’s clear that it’s in no one’s interests for patients to cycle in and out of Medicaid 4 times in as many years. Most Medicaid beneficiaries are private managed care plans, and all this churning eats up administrative cost, and means there is little incentive to do the difficult case management and care coordination that takes an investment today for savings that could be months or years away.
He points out that the researchers have shownthat extending Medicaid eligibility until the end of the calendar year or for twelve months can substantially reduce this churning – leading to better continuity of care and decreased administrative costs. Less than half of states so far have chosen to implement such a program for children and parents, and New York is the only state to offer extended enrollment to all enrolled adults.
Decreasing eligibility churning is one more piece of unfinished legislative business necessary to help Obamacare live up to its promise.
The graphic below shows how unlikely a Medicaid enrollee is to benefit from continuous enrollment (by state)
