Kansas State University


Issues in Health Reform

Month: May 2013

Clock ticking for states to decide on expanding criteria for Medicaid eligibility to take advantage of health reform

This Politico Pro article highlights the logistic issues currently facing states that have not yet decided to expand their Medicaid eligibility criteria and take advantage of the feds paying the full bill for several years.  Jason Millman also writes that for states that have not yet said yes it may be 2015 before they can tap into those monies.  Kansas is one of five states leaning toward not participating.  New York is leaning toward participating.  And the remainder have declared one way or the other.  For a good map of the current national situation click here.

By JASON MILLMAN | 5/23/13 5:09 AM EDT

“States still mired in the fight over the Obamacare Medicaid expansion are starting to give up on their first year of full funding — and it’s unclear whether they would be able to tap into the money before 2015.  Expansion remains an open question in about a dozen states after months of legislative fights. As more states continue to wrap up their budgets, some are already looking to next year’s legislative sessions as their next shot at the expansion, even amid calls for state legislatures to return for special sessions.”

“Role of Health Care Navigators Under Fire”

Navigators are set to be trained to help people enroll in the new marketplace of insurance plans.  As noted in this Wall Street Journal article several states are now enacting rules that are intended to protect consumers’ confidential information (e.g., social security numbers and tax info) by setting high standards (fingerprinting, licensure) of the assisters, much as insurance brokers are already.  On the surface this is certainly not a bad thing but it does create another level of barriers to assuring a smooth enrollment process this fall.

Another way of looking at this though suggests that perhaps not all is as it seems.  Extension and others who help many limited income families already have access to that confidential information (VITA sites) without any such standards.  So apparently those of limited income didn’t need the same protections of those with higher incomes.  I find this curious.

Some think the effort may be a disingenuous ploy implemented to once again make it more difficult for consumers to enroll, and to make this first year’s enrollment process go less than smoothly.  I find it important to remember that this marketplace model of health insurance that became Obamacare was originally an idea of conservative groups who did not want to see Medicare extended to all populations, or were not supportive of any of a number of other health insurance reform proposals.  A similar system has been successfully implemented in Massachusetts (when Romney was Governor there)KFF Massachusetts Health Care Refore July 2012.  And though conservative groups have clearly not be supportive of Obamacare, it is the closest to allowing the free market to continue to provide insurance, the kind of plan one would expect them to support.

Potential purchases of coverage in the Kansas Health Insurance Exchange: Who is likely in and who not?

The Kansas Health Institute report, “Insurance Exchange will provide many Kansas consumers with new options” estimates numbers for the state as a whole.  While more than 500,000 Kansans may consider purchasing insurance through the Exchange, only

  • 193,000 are most likely since they will qualify for tax credits/premium discounts;
  • 75,000 less likely because they don’t qualify for these;
  • 245,000 whose purchase behavior is unknown depending upon what their employers do; and
  • an additional 43,000 who will qualify for tax credits if Kansas does not expand Medicaid.  This latter population unfortunately will find insurance unaffordable even with the tax credit.

Summary from report:

2014, the Affordable Care Act’s individual mandate will require nearly all U.S. citizens to have health insurance. The health reform law also requires each state to have an online marketplace known as a health insurance exchange where people can obtain insurance.


This new issue brief — the eighth in a series focusing on health reform — examines which Kansans would be most likely to use a health insurance exchange.


Key findings of the brief include:


• More than 500,000 Kansans would have some reason to consider using the health insurance exchange to obtain coverage, though some are more likely to use it than others.


• About 1.7 million Kansans are likely to continue with the coverage they have now.


• The exchange will provide small employers and their workers with more options.


• The exchange will serve as a gateway for determining eligibility for federal tax credits as well as Medicaid and the Children’s Health Insurance Program.”

Women’s Health Quiz

The Kaiser Family Foundation has posted an online quiz to test your knowledge of women’s health and the effect of ACA on it.  Might be nice to use in exercises with consumers. And no, I did NOT get them all right.  There are a multitude of details in ACA and some I just haven’t learned or forget!

Five Basic Facts of the Uninsured

This Kaiser Family Foundation issue brief is a good, quick resource to understanding who the uninsured are in America.  Among the most salient points is that most (more than 3/4) of the uninsured live in a family with a worker.  This highlights several issues.

  1. that where you are employed, and the type of job you are able to hold, has always affected the type of insurance and health care you can receive.
  2. this is why ACA tried to encourage more employer sponsored insurance first by requiring insurance coverage of employees by employers of over 50 FTE and second by giving tax incentives for those who employed under 25FTEs.
  3. this is also why ACA put into place a new option for employees who couldn’t find insurance at work…these are the online marketplaces (the Exchanges)
  4. finally, because insurance was still going to be unaffordable for many, especially the working poor and their dependents, the feds were going to help states pay for expanding their Medicaid eligibility criteria to include those who would still be unable to afford private insurance.  KanCare has been pivotal in keeping kids in poor and working class families insured (under 225% of FPL, $4416 monthly income family of 4).

What is the impact on the federal budget by allowing businesses to take health insurance as a tax write-off?

This report analyzes the loss to the federal budget by allowing this practice.  This practice was initiated because it encouraged employers to pay for employees’ insurance plans.  Health insurance has, since World War II, been an important recruiting tool.  Businesses with better health benefits could choose from a larger more skilled employee pool.  It’s been a trade off between higher salaries and more extensive benefit packages.  ACA now requires taxing some of the insurance plans offered.  These are now referred to as “Cadillac” plans with the intonation that these plans are perhaps somewhat lavish and therefore not really necessary.  Those who have come to expect that type of complete coverage of their health care needs don’t think the plans are lavish but rather customary and essential.  That’s not the debate here.  This is just showing by how much the general federal deficit could be reduced if the practice of allowing employers to offer such extensive plans and claim tax exemptions for them were eliminated.  Policy analysts have oft referred to these tax exempt plans as money lost to the federal coffers.