Friday, January 21, 2022

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Article Index

Websites:

The Henry J. Kaiser Family Foundation, Medicaid’s Role for Black Americans, http://www.kff.org/medicaid/upload/8188.pdf (accessed Feb. 11, 2012). Pages: 2.

This article provides census data and analysis related to the insurance coverage of Black Americans. The articles points out that, in 2009*, almost one in three Blacks were covered by Medicaid. Additionally, more than one in five Blacks was completely uninsured. Approximately 75% of poor and near-poor Blacks were covered by Medicaid. What about the other 25%? Finally, there are substantial revisions to the Medicaid program, via the APA, that will make an additional four million Blacks eligible for Medicaid.

*All data is taken from 2009

 

The Henry J. Kaiser Family Foundation, A Guide to the Supreme Court’s Review of the 2010 Health Care Reform Law, http://www.kff.org/healthreform/upload/8270-2.pdf (accessed Feb. 20, 2012). Pages: 10.

This article addresses the main issues to be addressed in oral arguments to the Supreme Court in late March 2012. The primary issues of Constitutional concern are: The individual mandate of insurance coverage and the expansion of Medicaid coverage.

Medicaid generally covers pregnant women and children under the age of six at or below 133% of the federal poverty level (FPL), children ages six through 18 with family incomes at or below 100% of the FPL, and adults who qualify for social security based on low income and disability status (population is generally 65 or older). The expansion to Medicaid eligibility seems to extend to most low income people (not just women and children) who are at or below 133% of the FPL. This expansion is anticipated to provide eligibility for an additional 16 million Americans. It seems that one of the concerns from the perspective of the states is the cost associated with coverage of this additional population as Medicaid funding is supplied jointly by states and the federal government. The government will initially foot the bill of the expanded coverage, but the government’s contributions will decrease in subsequent years, pushing the cost to the states.

 

The Henry J. Kaiser Family Foundation, Explaining Health Care Reform: Questions about Medicaid’s Role, http://www.kff.org/healthreform/upload/7920-02.pdf (accessed Jan. 23, 2012). Pages: 4.

This article addresses a number of the widely-discussed revisions to the Medicaid program that are scheduled to take place under the Affordable Care Act, including: the expansion in Mediciad eligibility, the individual mandate for insurance coverage, subsidies provided to help low-income persons obtain health insurance.

 

U.S. Department of Health and Human Services, Medical Loss Ratio: Getting Your Money’s Worth on Health Insurance, http://www.healthcare.gov/news/factsheets/2010/11/medical-loss-ratio.html (accessed Feb. 11, 2012). Pages: 4.

Insurance companies have been portrayed as villains in the healthcare industry because of the profits that continue to grow even as the country has struggled through the recent recession. This article addresses a number of the changes in the Affordable Care Act that will increase the transparency and accountability of insurance companies.

In addition to requiring insurance companies to report how premium dollars are spent, insurance companies are required to spend at least 80% of premium dollars received on medical care and quality improvements. These requirements will serve one the Affordable Care Act’s many goals – To arm consumers with information about their health care options thus causing consumers to take a more active role in the health care status.

One problem experienced by low income people of color is limited access to quality health services. The Affordable Care Act contains provisions to increase financial investment in community health centers, one of the more common location where low-income individuals go to receive care. Subsequently, this is expected to improve the number of visits by low-income individuals, as well as the care received at these locations.

 

The Henry J. Kaiser Family Foundation, The Digital Divide and Access to Health Information Online, http://www.kff.org/kaiserpolls/upload/8176.pdf (April 2011). Pages: 2.

The Affordable Care Act contains provisions that require the health information related to the federal programs and insurance alternatives be posted on the internet. This article provided demographic data that showed that almost four of 10 Blacks that earn less than $40K per year do not have a computer in the home. Additionally, of the same population, only four of 10 have used the internet to access health information. This leads to the conclusion that efforts should be made to increase awareness of the availability of health resources online, specifically targeting low income individuals who will likely be impacted by the expansion of the Affordable Care Act.

 

Lisa Potetz, Juliette Cubanski and Tricia Neuman, Medicare Spending and Financing, http://www.kff.org/medicare/upload/7731-03.pdf (accessed Feb. 7, 2012). Pages: 20.

This article provides a very broad overview of the Medicare program and many of the financial components of the program. The Medicare program is administered and funded entirely by the federal government. The program is pervasive, with Medicare spending accounting for 20% of all dollars spent on health services in 2008. Additionally, Medicare spending represented 15% of the United States’ federal budget in 2010 and is expected to account for more than 17% of the federal budget by 2020. One of the most prominent financial burdens on the Medicare program is the aging population in the United States. Between the years of 1995 and 2009 Medicare enrollment grew by an average of 623,000 enrollees each year. Between the years 2010 and 2030, Medicare enrollment is expected to grow by an average of 1.6 million enrollees each year, putting additional strain on resources.

 

The Henry J. Kaiser Family Foundation, Health Reform and Communities of Color: Implications for Racial and Ethnic Health Disparities, http://www.kff.org/medicare/upload/8016-02.pdf (accessed Feb. 11, 2012). Pages: 14.

People of color comprise 50% of the total uninsured population in the United States. This article explores the efforts made in the Affordable Care Act to address the cultural and racial disparities in healthcare coverage and access to healthcare resources.

This article quite adeptly points out that the Affordable Care Act’s provisions related to Medicaid’s eligibility expansion do not necessarily equate to an identical increase in enrollment. States will retain considerable latitude in enrollment procedures which currently work to exclude at least some eligible persons that would enroll in Medicaid with more simple procedures.

Another problem that disproportionately affects low income persons enrolled in Medicaid is limited availability of quality physicians providing care to Medicaid enrollees. This problem is generally related to reimbursement rates under Medicaid. The Affordable Care Act imposes a temporary increase in rates to fall more closely in line with Medicare reimbursement rates to incentivize physicians to provide services to enrollees.

 

The Henry J. Kaiser Family Foundation, Explaining Health Care Reform: How Will the Affordable Care Act Affect Small Businesses and Their Employees?, http://www.kff.org/medicare/upload/8275.pdf (accessed Feb. 11, 2012). Pages: 3.

Small businesses (businesses with no more than 50 employees) have notoriously failed to provide employees with adequate employer-sponsored health benefits. In 2011 more than 40% of small businesses offered no health benefits to employees compared to three per cent of businesses with more than 100 employees that did not provide health benefits to employees. The Affordable Care Act attempts to increase the availability of employer-sponsored health benefits to employees in small businesses. Insurance plans purchased by small businesses will be required to provide a minimum level of coverage to employees.

To increase the availability of employer-sponsored health benefits plans of small businesses, the Affordable Care Act imposes penalties on small businesses that do not provide employees with access to affordable insurance plans. Additionally, some small businesses with fewer than 25 employees will be eligible for tax credits for providing employer-sponsored plans (with some limitations).

 

Marsha Lillie-Blanton, Julia Paradise, Megan Thomas, Paul Jacobs and Bianca DiJulio, Racial/Ethnic Disparities in Access to Care Among Children: How Does Medicaid Do in Closing the Gaps?, http://www.kff.org/minorityhealth/upload/8031.pdf (accessed Feb. 14, 2012). Pages: 15.

This article examines the health disparities among children enrolled in the Medicaid program as compared to children who are either uninsured or covered by private insurance. The four indicators of access used in the analysis include: usual source of care, failure to have at least one ambulatory medical visit in the past year, persons reporting problems getting to necessary care, and persons reporting problems seeing a specialist. One of the more notable findings in this report is that while insurance increases access to care for children of color, barriers to access to care tend to disproportionately affect children of color.

 

The Henry J. Kaiser Family Foundation, Medicaid and the Uninsured: Key Questions About Medicaid and Its Role in State/Federal Budgets and Health Reform, http://www.kff.org/medicaid/upload/8139.pdf (accessed Mar. 18, 2012). Pages: 6.

The Affordable Care Act makes significant changes to the Medicaid program and this article serves as an overview of some of the changes incorporated in the statute. The article begins by providing a baseline review of Medicaid and its intended purpose, which is to provide a base level of healthcare coverage for low income and high need Americans. A problem that becomes evident, perhaps unwittingly, from the information in this article is the relationship between populations enrolled in Medicaid and the proportion of the total dollars spent on the respective populations. For example, dual eligibles (those who are eligible for Medicare and Medicaid) account for approximately 15% of Medicaid spending, but take up approximately 40% of all Medicaid spending. Additionally, elderly and disabled enrollees account for 25% of total Medicaid enrollment but consume about 66% of Medicaid dollars. This implores the observation that Medicaid dollars may be diverted from the intended beneficiaries and given to another population. The Affordable Care Act takes strides to remedy this disparity by expanding the eligibility of Medicaid by eliminating the requirement of having a dependent and increasing the income eligibility thresholds.

 

The Henry J. Kaiser Family Foundation, Income-relating Medicare Part B and Part D Premiums Under Current Law and Recent Proposals: What are the Implications for Beneficiaries?, http://www.kff.org/medicare/upload/8276.pdf (accessed Feb. 20, 2012). Pages: 11.

This article provides an overview of Medicare Parts B & D, respectively, outlining the efforts of policymakers to subsidize the increasing cost of the Medicare program. Some proposals seek to increase enrollment premiums across the board, while other proposals implement income-related increases in premiums. It is estimated that, with implementation of the income-related proposals to Medicare Parts B &D, more than 20 million beneficiaries will be subject to the income-related premiums, compared to approximately 7 million beneficiaries under current law.

 

Office of the Legislative Counsel, Compilation of Patient Protection and Affordable Care Act, http://housedocs.house.gov/energycommerce/ppacacon.pdf (accessed 4/13/12). Pages: 24.

One of the key provisions of the Patient Protection and Affordable Care Act (“ACA”) is the law’s eligibility expansion provision. Eligibility expands to include persons under the age of 65, who are not pregnant, and whose income does not exceed 133% of the federal poverty line. This expansion serves as a significant departure from Medicaid’s initial eligibility ties to the welfare program. The significant cost of covering newly eligible persons will, initially, be borne solely by the federal government through increased federal contribution for this new population of beneficiaries.

Through the law, the government takes a more purpose-focused approach by providing financial incentives for states to implement preventive programs and meeting health outcomes targets. This seems to show the government’s desire to provide more than a healthcare program in name only, but focusing on creating a healthier population.

The ACA also contains provisions that specifically relate to improving the access to health services and the health status of minorities. The federal government will appropriate funds for the improvement of minority health through increased access and education until the year 2016.

The ACA also addresses provider enrollment by increasing the reimbursement rate for Medicaid to at least match the Medicare rate. This will specifically address the issue of primary care physicians electing to not provide care to Medicaid populations because of low reimbursement rates. It must be noted that these increased rates are only in effect for 2013 and 2014.

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