Source: Michael Ollove, Stateline, December 17, 2018
Perhaps the chief takeaway from the rejected citizen initiative to expand Medicaid in Montana last month is this: Be careful when you poke a giant.
Montana was one of four red states with Medicaid expansion on the ballot, and the only one where it failed. And the reason why, many close observers both inside and outside of the state agree, almost certainly came down to a tactical decision to link expansion to an increase in the state’s tobacco tax.
Supporters thought that strategy would boost their effort with voters, but it attracted Big Tobacco into the fight, along with the $17.2 million it spent, much of it on a television advertising blitz. Opponents raised nearly $19 million to defeat the measure, finance reports filed with the state show.
Proponents, with about $9.7 million to spend, simply couldn’t keep up….
Source: S&P Global Ratings, December 17, 2018
Last week a federal judge in Texas struck down the Affordable Care Act as unconstitutional in a lawsuit brought by 20 state attorneys general. In S&P Global Ratings’ view, if this ruling is not overturned the credit quality of many health care providers, insurers, and states could be hurt….
Source: U.S. Government Accountability Office, GAO-19-208SP, December 13, 2018
From the summary:
What’s the prognosis for the fiscal health of state and local governments across the nation?
Our annual outlook suggests the sector will have an increasingly tough time covering their bills over the next 50 years. Our model shows both revenue and spending will increase; however, spending will rise faster. Revenues may be insufficient to sustain the amount of government service currently provided.
Our model also suggests health care costs will largely drive the spending increases—in particular, Medicaid spending and spending on health benefits for state and local government employees and retirees.
Source: Ariel Marek Pihl, Gaetano Basso, Journal of Policy Analysis and Management, Volume 38 Issue 1, Winter 2019
From the abstract:
The effects of paid parental leave policies on infant health have yet to be established. In this paper we investigate these effects by exploiting the introduction of California Paid Family Leave (PFL), the first program in the U.S. that specifically provides working parents with paid time off for bonding with a newborn. We measure health using the full census of infant hospitalizations in California and a set of control states, and implement a differences‐in‐differences approach. Our results suggest a decline in infant admissions, which is concentrated among those causes that are potentially affected by closer childcare (and to a lesser extent breastfeeding). Other admissions that are unlikely to be affected by parental leave do not exhibit the same pattern.
Source: Amy J. Harzke and Sandi L. Pruitt, Journal of Health and Human Services Administration, Vol. 41 No. 3, 2018
From the abstract:
Nationally representative data collected by the Bureau of Justice Statistics (BJS) have shown increasing and elevated prevalence of a number of non-infectious chronic medical conditions in criminal justice populations relative to the non-institutionalized population. Prevalence of these conditions, including hypertension and arthritis, are especially high among elderly and female prisoners and jail inmates. State- and site- specific prevalence estimates, however, have revealed patterns that are somewhat inconsistent with BJS national data. We summarize the extant literature regarding prevalence of chronic medical conditions in U.S. prison and jail settings, determinants of these conditions across the phases of criminal justice involvement, and potential opportunities for reducing and managing the burden of chronic medical conditions in criminal justice populations. We provide research and policy recommendations for improving measurement of the burden of chronic medical conditions in criminal justice populations, provision of healthcare in correctional settings, and post-release continuity of care and community reentry.
Source: Shihyun Noh and Christian L. Janousek, Journal of Health and Human Services Administration, Vol. 41 No. 2, Fall 2018
From the abstract:
In state implementation of the Affordable Care Act (ACA) health insurance exchanges, sixteen states decided to create and administer their own exchanges, determining the institutional location of the exchanges. This institutional design of implementing organizations affects aspects of state policy implementation of the health exchanges, reflecting the intentions of state officials to exert control over the administration of operations and other decisions such as funding sources. This research examines whether state decisions regarding agency assignment of the ACA health exchanges were associated with political, economic, and historical-cultural explanations. This study provides evidence that, in the decision of the location of health insurance exchanges, state officials were influenced by the factors of state budget shortfalls and state histories of creating independent agencies, but not by divided government, compound divided government and state personnel capacity.
Source: S&P Global Ratings, November 28, 2018
Other postemployment benefit (OPEB) liabilities, which consist primarily of retiree health care plans, are a growing concern for certain states’ credit quality and require attention to control higher future costs. Total unfunded state OPEB liabilities have increased significantly for the third year in a row, according to S&P Global Ratings’ latest survey of U.S. states.
Source: Kaiser Family Foundation, December 7, 2018
The Affordable Care Act (ACA) led to historic gains in health insurance coverage by extending Medicaid coverage to many low-income individuals and providing Marketplace subsidies for individuals below 400% of poverty. The number of uninsured nonelderly Americans decreased from over 44 million in 2013 (the year before the major coverage provisions went into effect) to just below 27 million in 2016. However, in 2017, the number of uninsured people increased by nearly 700,000 people, the first increase since implementation of the ACA. Ongoing efforts to alter the ACA or to make receipt of Medicaid contingent on work may further erode coverage gains seen under the ACA. This fact sheet describes how coverage has changed in recent years, examines the characteristics of the uninsured population, and summarizes the access and financial implications of not having coverage.
Source: Chloe N. East, Center for Poverty Research – University of California, Policy Brief, Vol. 7 no. 4, November 2018
The Food Stamp Program (FSP, known since 2008 as the Supplemental Nutrition Assistance Program, or SNAP) is one of the largest safety-net programs in the United States. It is especially important for families with children. However, the FSP eligibility of documented immigrants has shifted on multiple occasions in recent decades. When I studied the health outcomes of children in documented immigrant families affected by such shifts between 1996 and 2003, I found that just one extra year of parental eligibility before age 5 improves health outcomes at ages 6-16. This suggests that expanding food-stamp access for such families has lasting long-run benefits for their children and may help to reduce public medical expenditures in the medium term.
– Immigrants’ loss of eligibility reduced participation in the Food Stamp Program among U.S.-born children of immigrants by 50%, and reduced the average benefits they received by 36%.
– Loss of parental food-stamp eligibility before age five has clear negative effects on developmental health outcomes and on parental reports of the child’s health in the medium-run.
– An additional year of food-stamp access in early life reduces medical expenditures in the medium-run by roughly $140 per child.
Source: Segal Consulting, Public Sector Data Fall 2018
From the summary:
Increases in Medical and Prescription Drug Costs Projected to Be Lower for 2019
Medical and prescription drug cost trends, for both actives and non-Medicare retirees, are projected to be lower in 2019 than in previous years.
That’s the headline finding from Segal’s 2019 Health Plan Cost Trend Survey, which surveyed more than 100 managed care organizations (MCOs), health insurers, pharmacy benefit managers (PBMs) and third-party administrators (TPAs).
Other Key Findings
– Medical plan cost trends are projected to be lower than 2018 projections.
– Actual medical and prescription drug trend results for 2017 were significantly lower than carrier projections for 2017.
– Actual prescription drug plan cost trends for 2017 were the second lowest in the last 13 years.
– Price inflation continues to be the primary driver of overall medical and prescription drug cost trends.
– Network physician reimbursement rate increases are projected to increase by less than 2 percent for both primary care and specialists, below overall CPI rates.
– Prescription drug cost-management strategies and improved vendor contracting are still plan sponsors’ top priorities.