Medicaid

HEALTH CARE: HHS Guide to Stimulus Spending

Want to track the health care money in the stimulus package? Have we got a web site for you.

The Department of Health and Human Services has created a special office to distribute the $137 billion in Recovery Act funds under HHS purview. The Office of Recovery Act Coordination will be lead by Dennis Williams, formerly of HRSA. Details of spending, grants etc will be at www.hhs.gov/recovery.

More than $3 billion has been distributed so far, mostly to community health centers and Medicaid.

 

COVERAGE: Implementing the Medicaid Provisions of the Stimulus Bill

Signing a $787 billion economic stimulus package—that was the easy part. Actually spending $787 billion to promote economic recovery—that's a little more difficult.

The American Recovery and Reinvestment Act of 2009 (ARRA) sought to stimulate the economy while laying the foundation for long-term economic growth. The Kaiser Family foundation has an excellent overview of the bill's specific Medicaid and health provisions, as well as a breakdown of state-specific allocations.

Now, as real money begins to flow, the plan's implementers are being forced to balance the sometimes competing goals of spending quickly and spending smartly.

The challenge is particularly clear in Medicaid. The stimulus provided $87 billion in additional federal funding for Medicaid. The money is intended to help states maintain Medicaid coverage during an economic downturn—a time when state revenues are declining at the same time enrollment in public coverage is rising.

HEALTH REFORM: Stimulus an Important Step for Helping the Unemployed and Uninsured

This post appears on the National Journal's Health Care Experts Blog where you can also see what other health policy analysts have to say on economic stimulus package.

The American Recovery and Reinvestment Act was designed to create or save 3.5 million jobs. Subsidies for health insurance were created with a couple of ideas in mind:

  1. Low-income people are more likely than high-income people to spend money as opposed to saving it. We need to engender spending—and more spending in multiplier effects—to restore incentives to invest and hire (or rehire) workers.
  2. Economic downturns increase the strain on safety net programs in the states.

Subsidies for COBRA coverage and increased support for the Medicaid program will engender increased spending, especially by lower-income individuals and the people that sell goods and services to them. Over time, this spending will multiply in the economy as a whole. Furthermore, providing states with additional funding for the Medicaid program will help stabilize state budgets and stave off additional budget and employment cuts.

HEALTH POLITICS: Skip the Flowers and Chocolate, Show Economy You Care With Health Reform

Congress is set to pass a $787 billion economic stimulus package—with more than a $130 billion in health-related funding. The House is expected to vote this afternoon, with the Senate scheduled to follow suit this evening.

Congressional leaders worked late into the night Thursday, to reconcile he House and Senate versions of HR 1. The conference report detailing the compromises in the final legislation is available from the House Committee on Rules. Just how late were lawmakers up hammering out the details? The 496-page pdf is filled with handwritten notes and last-minute edits.

COVERAGE: Unemployed and Uninsured

The latest employment numbers continue to paint a bleak picture for the economy. Almost 600,000 Americans lost their jobs last month, increasing the nation's unemployment rate from 7.2 percent in December to 7.6 percent in January.

Losses continued to be largest among manufacturing (207,000 jobs) and construction (111,000 job). Health care remained one of the few areas of job growth, adding 19,000 jobs in January.

Also released today, was a new analysis by the Lewin Group for Families USA looking at insurance coverage among the unemployed—specifically those with incomes below 200 percent of the federal poverty level ($44,100 in annual income for a family of four). Key findings:

IN THE STATES: Primary Care Progress in New Orleans

Having visited New Orleans and the Gulf Coast 18 months after Katrina, and having seen first-hand the stresses on the hospitals, ERs, clinics, mobile health vans and other health centers, it's heartening to hear even a little bit of good news emanating from that struggling city. Good news is what we heard yesterday about the progress toward building a viable, community-based primary care system in a city that had long been focused on big downtown hospitals, costly specialist care, and very, very busy, crowded ERs. In fact, storm-ravaged, long-suffering, stressed-out (add your favorite cliché here) New Orleans may show the rest of us a thing or two about how to create a patient-centered primary care system.

COVERAGE: Details, Details, Details

The devil, we're told, is in the details. We would have said Prada, but if you asked where the details matter most, we think you can make a strong argument for the programs of Medicaid and SCHIP.

First, there's the combination of state and federal funding that makes budgeting Byzantine. Add an array of eligibility, enrollment, and verification requirements. The result is a labyrinth fit for a Minotaur, yet often overwhelming to the populations these programs are intended to serve.

Which is why at a Kaiser Family Foundation briefing Friday on Children's Health Coverage: What's Next, we felt a little like Anne Hathaway, post makeover, in the Devil Wears Prada, suddenly seeing the real impact of details and policies on these programs.

KFF's Julia Paradise (slides) began the day reviewing work from the foundation on the impact of health coverage on low and middle income families. Some quick facts:

HEALTH REFORM: Making A Down Payment Work

Traditionally, the down payment for a prospective home buyer has been around 20 percent (hat-tip to David and New America's Asset Buidling crew). If that's the case, then the $825 billion in economic stimulus plan released today by House Democrats looks like a serious down payment on health reform. More than 25 percent of $550 billion in new federal spending us going toward health-related items (the remaining $275 billion is slated for temporary tax cuts).

You'll find the full the 258-page bill here, an accompanying report here, and a press summary here. Below, we've highlighted some of the major health care components of the proposed legislation:

HEALTH REFORM: Looking at Health Policy From Both Sides Now

USA Today’s Julie Appleby lines up the odds for and against health care reform in the new administration. In addition to the usual “we can’t afford to” versus “we can’t afford not to” arguments (President-elect Obama has declared himself in the "can’t afford not to" camp) she has a great outside-the-Beltway comment. Phyllis Smith, 60, an uninsured Obama backer from Texas who can’t afford her blood pressure and diabetes medicine wonders with the world being the giant mess it’s in, whether Obama can try to fix it all at once.

"With the condition this world is in right now, that man has his hands full," she told the newspaper. "Whether I get my high-blood-pressure medicine is not going to be high on his priority list. It will take time. … Until our Congress agrees to work together, there's not going to be a whole lot of hope."

Back here inside the Beltway, we do see some signs that Congress might be ready to work together, although it won’t all be smooth sailing. But we know that House leaders as well as the Senate is revving up for action in 2009.

COVERAGE: Gaps No Bargain When it Comes to Health Insurance

We focus frequently on why health insurance matters, and new study published in the Annals of Internal Medicine (abstract) provides further evidence.

Looking at Medicaid coverage for more than 4.7 million residents of California from 1998 to 2002, the study found that gaps in coverage were associated with much higher rates of hospitalization for ambulatory care-sensitive conditions. These are conditions like asthma, diabetes, hypertension and heart failure that "can often be managed with timely and effective treatment in an outpatient setting, thereby preventing hospitalization." See the Commonwealth Fund's chart below, adapted from the study.